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CovidForm.html
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CovidForm.html
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<!doctype html>
<html lang="en">
<head>
<!-- Required meta tags -->
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1, shrink-to-fit=no">
<!-- Bootstrap CSS -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/css/bootstrap.min.css" integrity="sha384-Vkoo8x4CGsO3+Hhxv8T/Q5PaXtkKtu6ug5TOeNV6gBiFeWPGFN9MuhOf23Q9Ifjh" crossorigin="anonymous">
<title>Welcome Volunteers !</title>
<style>
body{
background-image: url('images/covidimg.jpg');
background-repeat: no-repeat;
background-attachment: fixed;
background-size: cover;
}
</style>
</head>
<body>
<form method ="post" action="connect.php">
<div class="form-row">
<div class="col-md-4 mb-3">
<label for="firstname"><b>First name</b></label>
<input type="text" class="form-control" name="firstname" required>
<div class="valid-feedback">
</div>
</div>
<div class="col-md-4 mb-3">
<label for="lastname"><b>Last name</b></label>
<input type="text" class="form-control" name="lastname" required>
<div class="valid-feedback">
</div>
</div>
<div class="col-md-4 mb-3">
<label for="username"><b>Username</b></label>
<div class="input-group">
<div class="input-group-prepend">
<span class="input-group-text" id="inputGroupPrepend3">@</span>
</div>
<input type="text" class="form-control" name="username" aria-describedby="inputGroupPrepend3" required>
<div class="invalid-feedback">
Please choose a username.
</div>
</div>
</div>
</div>
<div class="form-row">
<div class="col-md-6 mb-3">
<label for="city"><b>City</b></label>
<input type="text" class="form-control" name="city" required>
<div class="invalid-feedback">
Please provide a valid city.
</div>
</div>
<div class="col-md-3 mb-3">
<label for="state"><b>State</b></label>
<input type="text" class="form-control" name="state" required>
<div class="invalid-feedback">
Please select a valid state.
</div>
</div>
<div class="col-md-3 mb-3">
<label for="zip"><b>Zip</b></label>
<input type="text" class="form-control" id="zip" required>
<div class="invalid-feedback">
Please provide a valid zip.
</div>
</div>
</div>
<div class="address">
<label for="address"><b>Address</b></label>
<input type="text" class="form-control" id="address" required>
<div class="invalid-feedback">
Please provide a valid address
</div>
</div>
<br>
<br>
<div class="form-group">
<div class="form-check">
<input class="form-check-input" type="checkbox" value="" id="invalidCheck3" required>
<label class="form-check-label" for="invalidCheck3">
Agree to terms and conditions
</label>
<div class="invalid-feedback">
You must agree before submitting.
</div>
</div>
<br>
<br>
<a href= "index.html">
<button class="btn btn-primary" type="submit">Sign up</button>
</a>
</form>
<!-- Optional JavaScript -->
<!-- jQuery first, then Popper.js, then Bootstrap JS -->
<script src="https://code.jquery.com/jquery-3.4.1.slim.min.js" integrity="sha384-J6qa4849blE2+poT4WnyKhv5vZF5SrPo0iEjwBvKU7imGFAV0wwj1yYfoRSJoZ+n" crossorigin="anonymous"></script>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/umd/popper.min.js" integrity="sha384-Q6E9RHvbIyZFJoft+2mJbHaEWldlvI9IOYy5n3zV9zzTtmI3UksdQRVvoxMfooAo" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.4.1/js/bootstrap.min.js" integrity="sha384-wfSDF2E50Y2D1uUdj0O3uMBJnjuUD4Ih7YwaYd1iqfktj0Uod8GCExl3Og8ifwB6" crossorigin="anonymous"></script>
</body>
</html>