450 lines
28 KiB
PHP
450 lines
28 KiB
PHP
<x-app-layout>
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<x-slot name="header">
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<h2 class="text-xl font-semibold leading-tight text-gray-800 dark:text-gray-200">
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新增會員
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</h2>
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</x-slot>
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<div class="py-12">
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<div class="mx-auto max-w-3xl sm:px-6 lg:px-8">
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<div class="bg-white dark:bg-gray-800 shadow sm:rounded-lg">
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<div class="px-4 py-5 sm:p-6">
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@if (session('status'))
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<div class="mb-4 rounded-md bg-green-50 dark:bg-green-900/50 p-4" role="status" aria-live="polite">
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<p class="text-sm font-medium text-green-800 dark:text-green-200">
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{{ session('status') }}
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</p>
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</div>
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@endif
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<form method="POST" action="{{ route('admin.members.store') }}" class="space-y-6" aria-label="新增會員表單">
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@csrf
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<div>
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<label for="full_name" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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全名
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</label>
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<input
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type="text"
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name="full_name"
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id="full_name"
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value="{{ old('full_name') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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required
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>
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@error('full_name')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="member_number" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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會員編號
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</label>
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<input
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type="text"
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name="member_number"
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id="member_number"
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value="{{ old('member_number') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('member_number')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="email" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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電子郵件
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</label>
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<input
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type="email"
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name="email"
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id="email"
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value="{{ old('email') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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required
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>
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@error('email')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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<p class="mt-1 text-sm text-gray-500 dark:text-gray-400">
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啟用電子郵件將發送至此地址。
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</p>
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</div>
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<div class="grid gap-6 sm:grid-cols-2">
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<div>
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<label for="birth_date" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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出生年月日
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</label>
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<input
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type="date"
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name="birth_date"
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id="birth_date"
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value="{{ old('birth_date') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('birth_date')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="gender" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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性別
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</label>
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<select
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name="gender"
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id="gender"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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<option value="">未設定</option>
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<option value="male" @selected(old('gender') === 'male')>男</option>
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<option value="female" @selected(old('gender') === 'female')>女</option>
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<option value="other" @selected(old('gender') === 'other')>其他</option>
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</select>
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@error('gender')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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</div>
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<div class="grid gap-6 sm:grid-cols-2">
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<div>
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<label for="identity_type" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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身份別
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</label>
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<select
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name="identity_type"
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id="identity_type"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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<option value="">未設定</option>
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<option value="patient" @selected(old('identity_type') === 'patient')>病友</option>
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<option value="parent" @selected(old('identity_type') === 'parent')>父母</option>
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<option value="social" @selected(old('identity_type') === 'social')>社會人士</option>
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<option value="other" @selected(old('identity_type') === 'other')>其他</option>
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</select>
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@error('identity_type')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="identity_other_text" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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身份別其他說明
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</label>
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<input
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type="text"
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name="identity_other_text"
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id="identity_other_text"
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value="{{ old('identity_other_text') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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placeholder="若選其他請填寫"
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>
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@error('identity_other_text')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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</div>
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<div>
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<label for="national_id" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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身分證號
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</label>
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<input
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type="text"
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name="national_id"
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id="national_id"
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value="{{ old('national_id') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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autocomplete="off"
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>
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@error('national_id')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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<p class="mt-1 text-sm text-gray-500 dark:text-gray-400">
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將加密儲存以確保安全。
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</p>
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</div>
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<div class="grid gap-6 sm:grid-cols-3">
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<div>
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<label for="phone" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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行動電話
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</label>
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<input
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type="text"
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name="phone"
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id="phone"
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value="{{ old('phone') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('phone')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="line_id" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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Line ID
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</label>
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<input
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type="text"
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name="line_id"
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id="line_id"
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value="{{ old('line_id') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('line_id')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="phone_home" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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室內電話
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</label>
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<input
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type="text"
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name="phone_home"
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id="phone_home"
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value="{{ old('phone_home') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('phone_home')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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</div>
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<div>
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<label for="phone_fax" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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傳真
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</label>
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<input
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type="text"
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name="phone_fax"
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id="phone_fax"
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value="{{ old('phone_fax') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('phone_fax')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div class="grid gap-6 sm:grid-cols-2">
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<div>
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<label for="occupation" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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現職
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</label>
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<input
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type="text"
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name="occupation"
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id="occupation"
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value="{{ old('occupation') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('occupation')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="job_title" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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職稱
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</label>
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<input
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type="text"
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name="job_title"
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id="job_title"
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value="{{ old('job_title') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('job_title')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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</div>
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<div>
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<label for="employer" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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服務單位
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</label>
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<input
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type="text"
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name="employer"
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id="employer"
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value="{{ old('employer') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('employer')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="applied_at" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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申請日期
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</label>
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<input
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type="date"
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name="applied_at"
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id="applied_at"
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value="{{ old('applied_at') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('applied_at')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div class="grid gap-6 sm:grid-cols-2">
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<div>
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<label for="membership_started_at" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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會員資格開始日
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</label>
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<input
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type="date"
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name="membership_started_at"
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id="membership_started_at"
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value="{{ old('membership_started_at') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('membership_started_at')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="membership_expires_at" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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會員資格到期日
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</label>
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<input
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type="date"
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name="membership_expires_at"
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id="membership_expires_at"
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value="{{ old('membership_expires_at') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('membership_expires_at')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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</div>
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<div>
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<label for="address_line_1" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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地址第1行
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</label>
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<input
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type="text"
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name="address_line_1"
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id="address_line_1"
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value="{{ old('address_line_1') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('address_line_1')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="address_line_2" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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地址第2行
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</label>
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<input
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type="text"
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name="address_line_2"
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id="address_line_2"
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value="{{ old('address_line_2') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('address_line_2')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div class="grid gap-6 sm:grid-cols-2">
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<div>
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<label for="city" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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城市
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</label>
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<input
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type="text"
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name="city"
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id="city"
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value="{{ old('city') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('city')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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<div>
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<label for="postal_code" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
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郵遞區號
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</label>
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<input
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type="text"
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name="postal_code"
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id="postal_code"
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value="{{ old('postal_code') }}"
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class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
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>
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@error('postal_code')
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<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
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@enderror
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</div>
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|
</div>
|
|
|
|
<div>
|
|
<label for="emergency_contact_name" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
|
|
緊急聯絡人姓名
|
|
</label>
|
|
<input
|
|
type="text"
|
|
name="emergency_contact_name"
|
|
id="emergency_contact_name"
|
|
value="{{ old('emergency_contact_name') }}"
|
|
class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
|
|
>
|
|
@error('emergency_contact_name')
|
|
<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
|
|
@enderror
|
|
</div>
|
|
|
|
<div>
|
|
<label for="emergency_contact_phone" class="block text-sm font-medium text-gray-700 dark:text-gray-300">
|
|
緊急聯絡人電話
|
|
</label>
|
|
<input
|
|
type="text"
|
|
name="emergency_contact_phone"
|
|
id="emergency_contact_phone"
|
|
value="{{ old('emergency_contact_phone') }}"
|
|
class="mt-1 block w-full rounded-md border-gray-300 dark:border-gray-700 shadow-sm focus:border-indigo-500 dark:focus:border-indigo-600 focus:ring-indigo-500 dark:focus:ring-indigo-600 sm:text-sm dark:bg-gray-900 dark:text-gray-300"
|
|
>
|
|
@error('emergency_contact_phone')
|
|
<p class="mt-2 text-sm text-red-600 dark:text-red-400">{{ $message }}</p>
|
|
@enderror
|
|
</div>
|
|
|
|
<div class="flex justify-end gap-3">
|
|
<a href="{{ route('admin.members.index') }}" class="inline-flex items-center rounded-md border border-gray-300 dark:border-gray-600 bg-white dark:bg-gray-700 px-4 py-2 text-sm font-medium text-gray-700 dark:text-gray-300 hover:bg-gray-50 dark:hover:bg-gray-600 focus:outline-none focus:ring-2 focus:ring-indigo-500 dark:focus:ring-indigo-600 focus:ring-offset-2 dark:focus:ring-offset-gray-800">
|
|
取消
|
|
</a>
|
|
<button type="submit" class="inline-flex items-center rounded-md border border-transparent bg-indigo-600 dark:bg-indigo-500 px-4 py-2 text-sm font-medium text-white hover:bg-indigo-700 dark:hover:bg-indigo-600 focus:outline-none focus:ring-2 focus:ring-indigo-500 dark:focus:ring-indigo-600 focus:ring-offset-2 dark:focus:ring-offset-gray-800">
|
|
新增會員
|
|
</button>
|
|
</div>
|
|
</form>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</div>
|
|
</x-app-layout>
|