@include('admin.Master.header')

<main class="page-content">
	<div class="page-breadcrumb d-none d-sm-flex align-items-center mb-3">
		<div class="breadcrumb-title pe-3">Create Form</div>
	</div>
	<div class="row">
		<div class="col-lg-12">
			<form method="POST" action="{{ route('admin.store.details') }}">
				@csrf
				<div class="card">
					<div class="card-body">
						<div class="border p-3 rounded mb-3">
							<div class="row">
								<div class="col-4 mb-4">
									<label class="form-label">Full Name <span class="text-danger">*</span> (पूरा नाम)</label>
									<input type="text" name="fullName" class="form-control" placeholder="Full Name" value="{{ old('fullName') }}">
									@error('fullName')
									<div class="text-danger">{{ $message }}</div>
									@enderror
								</div>
								<div class="col-4 mb-4">
									<label class="form-label">Age <span class="text-danger">*</span> (आयु)</label>
									<input type="text" name="age" class="form-control numeric" placeholder="Age" value="{{ old('age') }}">
									@error('age')
									<div class="text-danger">{{ $message }}</div>
									@enderror
								</div>
								<div class="col-4 mb-4">
									<label class="form-label">Email Id <span class="text-danger">*</span> (ईमेल)</label>
									<input type="text" name="email" class="form-control" placeholder="Email Id" value="{{ old('email') }}">
									@error('email')
									<div class="text-danger">{{ $message }}</div>
									@enderror
								</div>
								<div class="col-4 mb-4">
									<label class="form-label">Contact Number (मोबाइल नंबर)</label>
									<input type="text" name="phone" class="form-control numeric" placeholder="Contact Number" value="{{ old('phone') }}">
								</div>
								<div class="col-4 mb-4">
									<label class="form-label">Country / State <span class="text-danger">*</span> (देश / राज्य)</label>
									<select class="form-control multiple-select" name="country" data-placeholder="Choose Country" id="admincountry">
										<option disabled readonly selected>Select State</option>
										<option class="font-weight-bold" value="ANDAMAN & NICOBAR" @selected(old('country') == 'ANDAMAN & NICOBAR')>ANDAMAN &
                                                NICOBAR</option>
										<option value="ANDHRA PRADESH" @selected(old('country') == 'ANDHRA PRADESH')>ANDHRA PRADESH
										</option>
										<option value="ARUNACHAL PRADESH" @selected(old('country') == 'ARUNACHAL PRADESH')>ARUNACHAL
											PRADESH</option>
										<option value="ASSAM" @selected(old('country') == 'ASSAM')>ASSAM</option>
										<option value="BIHAR" @selected(old('country') == 'BIHAR')>BIHAR</option>
										<option value="CHANDIGARH" @selected(old('country') == 'CHANDIGARH')>CHANDIGARH
										</option>
										<option value="CHATTISGARH" @selected(old('country') == 'CHATTISGARH')>CHATTISGARH
										</option>
										<option value="DADRA & NAGAR" @selected(old('country') == 'DADRA & NAGAR')>DADRA & NAGAR
										</option>
										<option value="DAMAN & DIU" @selected(old('country') == 'DAMAN & DIU')>DAMAN & DIU
										</option>
										<option value="DELHI" @selected(old('country') == 'DELHI')>DELHI
										</option>
										<option value="GOA" @selected(old('country') == 'GOA')>GOA</option>
										<option value="GUJARAT" @selected(old('country') == 'GUJARAT')>GUJARAT
										</option>
										<option value="HARYANA" @selected(old('country') == 'HARYANA')>HARYANA
										</option>
										<option value="HIMACHAL PRADESH" @selected(old('country') == 'HIMACHAL PRADESH')>HIMACHAL
											PRADESH</option>
										<option value="JAMMU & KASHMIR" @selected(old('country') == 'JAMMU & KASHMIR')>JAMMU &
											KASHMIR</option>
										<option value="JHARKHAND" @selected(old('country') == 'JHARKHAND')>JHARKHAND
										</option>
										<option value="KARNATAKA" @selected(old('country') == 'KARNATAKA')>KARNATAKA
										</option>
										<option value="KERALA" @selected(old('country') == 'KERALA')>KERALA
										</option>
										<option value="LADAKH" @selected(old('country') == 'LADAKH')>LADAKH
										</option>
										<option value="LAKSHDWEEP" @selected(old('country') == 'LAKSHDWEEP')>LAKSHDWEEP
										</option>
										<option value="MADHYA PRADESH" @selected(old('country') == 'MADHYA PRADESH')>MADHYA
											PRADESH</option>
										<option value="MAHARASHTRA" @selected(old('country') == 'MAHARASHTRA')>MAHARASHTRA
										</option>
										<option value="MANIPUR" @selected(old('country') == 'MANIPUR')>MANIPUR
										</option>
										<option value="MEGHALAYA" @selected(old('country') == 'MEGHALAYA')>MEGHALAYA
										</option>
										<option value="MIZORAM" @selected(old('country') == 'MIZORAM')>MIZORAM
										</option>
										<option value="NAGALAND" @selected(old('country') == 'NAGALAND')>NAGALAND
										</option>
										<option value="ORISSA" @selected(old('country') == 'ORISSA')>ORISSA
										</option>
										<option value="PUDUCHERRY" @selected(old('country') == 'PUDUCHERRY')>PUDUCHERRY
										</option>
										<option value="PUNJAB" @selected(old('country') == 'PUNJAB')>PUNJAB
										</option>
										<option value="RAJASTHAN" @selected(old('country') == 'RAJASTHAN')>RAJASTHAN
										</option>
										<option value="SIKKIM" @selected(old('country') == 'SIKKIM')>SIKKIM
										</option>
										<option value="TAMIL NADU" @selected(old('country') == 'TAMIL NADU')>TAMIL NADU
										</option>
										<option value="TELANGANA" @selected(old('country') == 'TELANGANA')>TELANGANA
										</option>
										<option value="TRIPURA" @selected(old('country') == 'TRIPURA')>TRIPURA
										</option>
										<option value="UTTARAKHAND" @selected(old('country') == 'UTTARAKHAND')>UTTARAKHAND
										</option>
										<option value="UTTAR PRADESH" @selected(old('country') == 'UTTAR PRADESH')>UTTAR
											PRADESH</option>
										<option value="WEST BENGAL" @selected(old('country') == 'WEST BENGAL')>WEST BENGAL
										</option>
										<option value="NEPAL" {{ old('country')=='NEPAL' ? 'selected' : '' }}>NEPAL
										</option>
										<option value="UK" @selected(old('country') == 'UK')>UK</option>
										<option value="USA" @selected(old('country') == 'USA')>USA</option>
										<option value="UAE" @selected(old('country') == 'UAE')>UAE</option>
										<option value="SINGAPORE" @selected(old('country') == 'SINGAPORE')>SINGAPORE
										</option>
										<option value="AUSTRALIA" @selected(old('country') == 'AUSTRALIA')>AUSTRALIA
										</option>
										<option value="OTHERS" @selected(old('country') == 'OTHERS')>OTHERS
										</option>
									</select>
								</div>
								<div class="col-4 mb-4">
									<label class="form-label">City <span class="text-danger">*</span> (शहर का नाम)</label>
									<input type="text" name="city" class="form-control" placeholder="City" value="{{ old('city') }}">
									@error('city')
										<div class="text-danger">{{ $message }}</div>
									@enderror
								</div>
							</div>
						</div>
					</div>
				</div>
				<div class="card">
					<div class="card-body">
						<div class="border p-3 rounded">
							<button class="btn btn-primary px-4 border-0">{{ trans('admin.buttons.save') }} (फार्म जमा करें)</button>
							<a href="{{ route('admin.details') }}" class="btn btn-secondary px-4 border-0">{{ trans('admin.buttons.cancel') }} (फार्म रद्द करें)</a>
						</div>
					</div>
				</div>
			</form>
		</div>
	</div>
</main>

@include('admin.Master.footer')
<script>
	const currentDate = new Date();
	const formattedTime = currentDate.toTimeString().slice(0, 5);
	document.getElementById('timeInput').value = formattedTime;
</script>