BloodBankProject/requestForm.php at main · Khatri-Sanjay/BloodBankProject · GitHub

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<?php include 'header.php'?>

<?php

    if(isset($_POST['submit'])) {

        include ("connection/config.php");

        $name = $_POST['Name'];
        $email = $_POST['Email'];
        $age = $_POST['Age'];
        $citizenShip_No = $_POST['CitizenShip_No'];
        $bloodGroup = $_POST['BloodGroup'];
        $bloodPound = $_POST['BloodPound'];
        $gender = $_POST['Gender'];
        $contact = $_POST['Contact'];
        $address = $_POST['Address'];
        $message = $_POST['Message'];

        $sqlquery = "INSERT INTO request (Name, Email, Age, CitizenShip_No, BloodGroup, BloodPound, Gender, Contact, Address, Message) VALUES ('$name', '$email','$age','$citizenShip_No','$bloodGroup','$bloodPound','$gender','$contact','$address','$message')";


            if (mysqli_query($conn, $sqlquery)){

                $success = "Request form submit succesfully";

            } else {
                echo "Error: " . $sqlquery . "<br>" . mysqli_error($conn);
            }

    }

?>

    <head>
        <title>Request Blood Form</title>
    </head>

    <marquee behavior="sliding" direction="left" loop="10">
        Donate Blood Save Life &emsp; &emsp; Donate Blood Save Life &emsp; &emsp;
        Donate Blood Save Life &emsp; &emsp; Donate Blood Save Life &emsp; &emsp;
        Donate Blood Save Life &emsp; &emsp; Donate Blood Save Life &emsp; &emsp;
        Donate Blood Save Life &emsp; &emsp; Donate Blood Save Life &emsp; &emsp;
    </marquee>

    <!-- Backgroud Image Section Starts From Here -->
    <section>
        <div class="image-container">
            <!-- <img src="./image/donate1.jpg" alt="Image"> -->
            <h1>रगत चाहियो ?</h1>
            <h3>Blood Request Form</h3>
        </div>
    </section>

      <div class="success">
          <?php

            error_reporting(E_ERROR | E_PARSE);

            echo $success;


          ?>
      </div>

    <!-- Donation From Section Starts From Here -->
    <center>
    <div class="container">
        <div class="title">Request Form</div>
        <div class="content">

        <form action="" name="regForm" method="POST" onsubmit="return formValidation()">
            <div class="user-details">

            <div class="input-box">
                <span class="details">Full Name</span>
                <input type="text" placeholder="Enter your name" id="Name" name="Name">
                <span style="color:red" id="rNameErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Email</span>
                <input type="email" placeholder="Enter your email" id="Email" name="Email">
                <span style="color:red" id="rEmailErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Blood Pound</span>
                <input type="number" placeholder="Enter quantity of blood pound" id="BloodPound" name="BloodPound">
                <span style="color:red" id="rBloodPoundErr"></span>
            </div>

            <div class="input-box">
                <span class="details">CitizenShip No.</span>
                <input type="text" placeholder="Enter CitizenShip Number" id="CitizenShip_No" name="CitizenShip_No">
                <span style="color:red" id="rCitizenErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Phone Number</span>
                <input type="text" placeholder="Enter your number" id="Contact" name="Contact">
                <span style="color:red" id="rContactErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Age</span>
                <input type="number" placeholder="Enter your age" id="Age" name="Age">
                <span style="color:red" id="rAgeErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Choose Blood Group</span>
                <select id="BloodGroup" name="BloodGroup">
                <option value="">None</option>
                <option value="A+ve">A+ve</option>
                <option value="A-ve">A-ve</option>
                <option value="B+ve">B+ve</option>
                <option value="B-ve">B-ve</option>
                <option value="AB+ve">AB+ve</option>
                <option value="AB-ve">AB-ve</option>
                <option value="O+ve">O+ve</option>
                <option value="O-ve">O-ve</option>
                </select>
                <br>
                <span style="color:red" id="rBloodGroupErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Gender</span>
                <select id="Gender" name="Gender">
                <option value="">None</option>
                <option name= "Gender" value="Male">Male</option>
                <option name= "Gender" value="Female">Female</option>
                <option name= "Gender" value="Others">Others</option>
                </select>
                <br>
                <span style="color:red" id="rGenderErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Adderss</span>
                <input type="text" placeholder="Enter your address" id="Address" name="Address">
                <span style="color:red" id="rAddressErr"></span>
            </div>

            <div class="input-box">
                <span class="details">Message</span>
                <textarea placeholder="Enter your message . . ." id="Message" name="Message" style="width: 330px;height: 100px; font-size: 16px;  padding-left: 15px; border-radius: 5px; border: 2px solid #ccc;"></textarea>
                <span style="color:red" id="rMessageErr"></span>
            </div>
            </div>

            <div class="button">
            <input type="submit" class="submit" value="Submit" name="submit">
            <!-- <button type="submit" name="submit" id="submit">Submit</button> -->
            </div>
        </form>

        </div>
        </div>
    </div>
    </center>

    <script src="./js/requestFormValidation.js"></script>

<?php include 'footer.php'?>