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donorform.php
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Registration form for donor</title>
<link rel="stylesheet" href="style.css">
<link href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css" rel="stylesheet" integrity="sha384-+0n0xVW2eSR5OomGNYDnhzAbDsOXxcvSN1TPprVMTNDbiYZCxYbOOl7+AMvyTG2x" crossorigin="anonymous">
</head>
<body>
<div class="regform">
<h1>Registration-Donor</h1>
</div>
<div class="main">
<form action="connect.php" method="POST">
<div class="form-group">
<div class="row ">
<div class="col">
<label for="fname">First Name<span class="required-mark"> *</span></label>
<input class="form-control" type="text" id="fname" name="firstname" placeholder="First Name" required>
</div>
<div class="col">
<label for="fname">Last Name <span class="required-mark"> *</span></label>
<input class="form-control" type="text" id="lname" name="lastname" placeholder="last Name" required>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col">
<label for="Age">Age <span class="required-mark"> *</span></label><br>
<input class="form-control form-rounded " type="text" name="Age" placeholder="Age" required>
</div>
<div class="col">
<label for="start">Date of Birth:<span class="required-mark">*</span></label><br>
<input type="date" class="form-control form-rounded" id="dob" name="dob" value="dd-mm-yy" required>
</div>
</div>
</div>
<br>
<div class="form-group">
<div class="row">
<div class="col">
<label class="col3" id="gender" style="margin-left: 40px;">Gender <span class="required-mark">*</span></label>
<br>
<div class="form-check form-check-inline" style="margin-left: 30px;">
<input class="form-check-input" type="radio" id="male" name="gender" value="Male" required>
<label class="form-check-label" for="inlineCheckbox1">Male</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="female" name="gender" value="Female" required>
<label class="form-check-label" for="inlineCheckbox2">Female</label>
</div>
<div class="form-check form-check-inline">
<input class="form-check-input" type="radio" id="other" name="gender" value="Other" required>
<label class="form-check-label" for="inlineCheckbox3">Other</label>
</div>
</div>
<div class="col">
<label for="bloodgroup"> Blood Group <span class="required-mark">*</span></label>
<select class="form-select " id="bloodgroup" name="bloodgroup">
<option selected>Choose...</option>
<option value="A">A</option>
<option value="A+">A+</option>
<option value="AB">AB</option>
<option value="AB+">AB+</option>
<option value="B-">B-</option>
<option value="B+">B+</option>
<option value="O+">O+</option>
<option value="O-">O-</option>
</select>
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col">
<label for="username">Email</label><br>
<input type="Email" class="form-control" id="Email" name="Email" placeholder="Email" required>
</div>
<div class="col">
<label for="mob">Mobile Number<span class="required-mark">*</span></label><br>
<input type="text" class="form-control form-rounded" id="mobile" name="Mobile" required="" autocomplete="off">
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col">
<label for="inputPassword4" class="form-label">Password<span class="required-mark">*</span></label>
<input type="password" class="form-control" id="password" name="password" placeholder="Password" required>
</div>
<div class="col">
<label for="inputPassword4" class="form-label">Confirm Passsword<span class="required-mark">*</span></label>
<input type="password" class="form-control" id="cpassword" name="cpassword" placeholder=" Confirm Password" required>
</div>
</div>
</div>
<div class="row">
<div class="col-md-6">
<label for="validationCustom03" class="form-label">City</label>
<input type="text" class="form-control" id="city" name="city" placeholder="City" required>
<div class="invalid-feedback">
Please provide a valid city.
</div>
</div>
<div class="col-md-3">
<label for="validationCustom04" class="form-label">State</label>
<input type="text" class="form-control" id="state" name="state" placeholder="State" required>
<div class="invalid-feedback">
Please select a valid state.
</div>
</div>
<div class="col-md-3">
<label for="validationCustom05" class="form-label">Zip</label>
<input type="text" class="form-control" id="zip" name="zip" placeholder="Zip" required>
<div class="invalid-feedback">
Please provide a valid zip.
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col">
<label for="start">Last Date of Blood Donation:<span class="required-mark">*</span></label><br>
<input type="date" class="form-control form-rounded" id="blooddonation" name="blooddate" value="dd-mm-yy" required>
</div>
<div class="col">
<label for="start"> Covid Vaccine Date:</label><br>
<input type="date" class="form-control form-rounded" id="vaccinedate" name="vaccinedate" value="dd-mm-yy" required>
</div>
</div>
</div>
<div class="form-group ">
<div class="row">
<div class="col">
<label for="donateblood"> Choose Preference <span class="required-mark">*</span></label>
<select class="form-select" name="donateblood" aria-label="Default select example">
<option selected>Select</option>
<option value="Emergency Donate">Emergency Donate</option>
<option value="General Donate">General Donate</option>
</select>
</div>
<div class="col">
<label for="covidnegative">Covid Negative Report</label>
<select class="form-select" name="covidnegative" aria-label="Default select example">
<option selected>Select</option>
<option value="Yes">Yes</option>
<option value="No">No</option>
</select>
</div>
</div>
</div>
<div class="col-md-12 text-center">
<button type="submit" class="btn btn-primary" style="width: 400px;">Submit</button>
</div>
</div>
</form>
</div>
</body>
</html>