167 lines
4.0 KiB
HTML
Executable File
167 lines
4.0 KiB
HTML
Executable File
<html xmlns="http://www.w3.org/1999/xhtml" lang="en-US">
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<head>
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<meta charset="utf-8" />
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<title>CINÉ CRÉATIS - Dossier d'inscription page 1</title>
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<link rel="home" href="" />
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<link rel="stylesheet" type="text/css" href="dossier/css/reset.css">
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<link rel="stylesheet" type="text/css" href="dossier/css/screen.css" media="screen">
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<link rel="stylesheet" type="text/css" href="dossier/css/print.css" media="print">
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</head>
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<body>
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<section id="header" class="top">
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<div id="photo" >
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<img src="dossier/assets/cinecreatis-picture-block.png"/>
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</div>
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<div id="title">
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<h1>Dossier d'inscription</h1>
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<span class="date">2015.2016</span>
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</div>
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</section>
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<section>
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<div class="columns">
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<div id="file-infos" class="col col-6">
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<div class="field-group"><span class="label">Dossier n° : </span><span class="field"></span></div>
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<div class="field-group"><span class="label">Reçu le : </span><span class="field">{date@DateTime->new().format('d.m.Y')}</span></div>
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</div>
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<div class="col col-6">
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<h2>Formation choisie</h2>
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<div class="radio-group">1<span class="small">ère</span> année</div>
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<div class="radio-group">2<span class="small">ème</span> année</div>
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<div class="radio-group">3<span class="small">ème</span> année</div>
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</div>
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</div>
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</section>
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<section class="form-group">
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<h2>Votre état civil</h2>
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<div class="columns">
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<div class="col">
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<div class="field-group"><span class="label">Nom : </span><span class="field">{nom}</span></div>
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<div class="field-group"><span class="label">Date de Naissance : </span><span class="field">{naissanceDate}</span></div>
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<div class="field-group"><span class="label">Adresse :</span><span class="field">{adresse}</span></div>
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<div class="field-group"><span class="label">Email :</span><span class="field">{email}</span></div>
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</div>
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<div class="col">
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<div class="field-group"><span class="label">Prénom : </span><span class="field">{prenom}</span></div>
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<div class="field-group"><span class="label">Lieu de naissance : </span><span class="field">{naissanceLieu}</span></div>
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<div class="field-group-double"><span class="label">Code Postal :</span><span class="field">{codePostal}</span><span class="label">Ville :</span><span class="field">{ville}</span></div>
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<div class="field-group"><span class="label">Téléphone fixe :</span><span class="field">{telephone}</span></div>
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<div class="field-group"><span class="label">Téléphone mobile :</span><span class="field"></span></div>
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</div>
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</div>
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</section>
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<section class="form-group">
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<h2>Vos parents</h2>
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<div class="columns">
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<div class="col">
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<div class="field-group"><span class="label">Nom de la mère : </span><span class="field"></span></div>
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<div class="field-group"><span class="label">Date de Naissance : </span><span class="field"></span></div>
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<div class="field-group"><span class="label">Adresse :</span><span class="field"></span></div>
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<div class="only-field"></div>
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<div class="field-group"><span class="label">Profession :</span><span class="field"></span></div>
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<div class="field-group"><span class="label">Téléphone fixe :</span><span class="field">{telparent}</span></div>
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</div>
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<div class="col">
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<div class="field-group"><span class="label">Prénom de la mère : </span><span class="field"></span></div>
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<div class="field-group"><span class="label">Lieu de naissance : </span><span class="field"></span></div>
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<div class="field-group"><span class="label">Code Postal :</span><span class="field"></span></div>
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<div class="field-group"><span class="label">Ville :</span><span class="field"></span></div>
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<div class="field-group"><span class="label">Email :</span><span class="field"></span></div>
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<div class="field-group"><span class="label">Téléphone mobile :</span><span class="field"></span></div>
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</div>
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</div>
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</section>
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</body>
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</html>
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