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form1.html
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form1.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">
<meta name="description" content="">
<meta name="author" content="">
<link rel="icon" href="/docs/4.1/assets/img/favicons/favicon.ico">
<!-- Bootstrap CSS -->
<link rel="canonical" href="https://getbootstrap.com/docs/4.1/examples/checkout/">
<!-- Bootstrap core CSS -->
<link href="../../dist/css/bootstrap.min.css" rel="stylesheet">
<!-- Custom styles for this template -->
<link href="form-validation.css" rel="stylesheet">
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/css/bootstrap.min.css" integrity="sha384-MCw98/SFnGE8fJT3GXwEOngsV7Zt27NXFoaoApmYm81iuXoPkFOJwJ8ERdknLPMO" crossorigin="anonymous">
<link href="https://fonts.googleapis.com/css2?family=Muli:wght@500&display=swap" rel="stylesheet">
<!-- css file -->
<link rel="stylesheet" type="text/css" href="style.css">
<!-- icons file -->
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css">
<title>Book Testing</title>
</head>
<body class="bg-light">
<!-- ******************navbar******************** -->
<nav class="navbar sticky-top navbar-expand-lg navbar-light" style="background-color: white"> <!--nav bar color -->
<a class="navbar-brand" href="index.html">Logo</a>
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#navbarSupportedContent" aria-controls="navbarSupportedContent" aria-expanded="false" aria-label="Toggle navigation">
<span class="navbar-toggler-icon"></span>
</button>
<div class="collapse navbar-collapse" id="navbarSupportedContent">
<ul class="navbar-nav ">
<li class="nav-item ">
<a class="nav-link ml-5 mr-5 fa fa-home" href="index.html">Home <span class="sr-only">(current)</span></a>
</li>
<li class="nav-item ml-5 mr-5"><a class="nav-link fa fa-newspaper-o" href="https://www.mygov.in/covid-19/#updates" >News</a></li>
<li class="nav-item ml-3 mr-5"><a class="nav-link fa fa-globe" href="https://www.covid19india.org/" >Covid-19 Tracker</a></li>
<li class="nav-item ml-5 mr-5 "><a class="nav-link fa fa-user " href="#">About</a></li>
<li class="nav-item ml-5 mr-5"><a class="nav-link fa fa-info-circle" href="#Contact">More Info</a></li>
</ul>
</div>
</nav>
<!-- ************************************** nav ends ********************************************* -->
<!-- *************************************** form submission ************************************* -->
<div class="container-fluid" id="form1">
<div class="py-5 text-center">
<h2 class="display-3">Covid-19 Test Booking</h2>
<p class="lead">Submit your details truthfully as it is essential to find nearest testing centre, false details can result in cancellation of application.</p>
</div>
<div class="col-md-8 order-md-1 container ">
<form class="needs-validation" novalidate>
<div class="row">
<div class="col-md-6 mb-3">
<label for="firstName">First name<span class="text-muted">*</span></label>
<input type="text" class="form-control" id="firstName" placeholder="" value="" required>
<div class="invalid-feedback">
Valid first name is required.
</div>
</div>
<div class="col-md-6 mb-3">
<label for="lastName">Last name</label>
<input type="text" class="form-control" id="lastName" placeholder="" >
<div class="invalid-feedback">
Valid last name is required.
</div>
</div>
</div>
<div class="mb-3">
<label for="email">Email<span class="text-muted">*</span></label>
<div class="input-group">
<div class="input-group-prepend">
</div>
<input type="text" class="form-control" id="email" placeholder="you@example.com" required>
<div class="invalid-feedback" style="width: 100%;">
Your email is required. Please enter a valid email address for booking updates.
</div>
</div>
</div>
<div class="mb-3">
<label for="Moblie">Moblie <span class="text-muted">*</span></label>
<input type="tel" class="form-control" id="Mobile" placeholder="Mobile no.">
<div class="invalid-feedback">
Please enter a valid mobile number for booking updates.
</div>
</div>
<div class="mb-3">
<label for="address">Address line 1<span class="text-muted">*</span></label>
<input type="text" class="form-control" id="address" placeholder="1234 Main St" required>
<div class="invalid-feedback">
Please enter your current address.
</div>
</div>
<div class="mb-3">
<label for="address2">Address Line 2 <span class="text-muted">*</span></label>
<input type="text" class="form-control" id="address2" placeholder="Apartment or suite">
</div>
<div class="row">
<div class="col-md-5 mb-3">
<label for="country">Country<span class="text-muted">*</span></label>
<select class="custom-select d-block w-100" id="country" required>
<option value="">Choose...</option>
<option>India</option>
</select>
<div class="invalid-feedback">
Please select a valid country.
</div>
</div>
<div class="col-md-4 mb-3">
<label for="state">State<span class="text-muted">*</span></label>
<select class="custom-select d-block w-100" id="state" required>
<option value="">Choose...</option>
<option>Andaman and Nicobar</option>
<option>Andhra Pradesh</option>
<option>Arunachal Pradesh</option>
<option>Assam</option>
<option>Bihar</option>
<option>Chandigarh</option>
<option>Chhattisgarh</option>
<option>Daman and Diu</option>
<option>Delhi</option>
<option>Goa</option>
<option>Gujrat</option>
<option>Haryana</option>
<option>Himachal Pradesh</option>
<option>Jammu and Kashmir</option>
<option>Jharkhand</option>
<option>Karnataka</option>
<option>Kerala</option>
<option>Ladakh</option>
<option>Lakshadweep</option>
<option>Madhya Pradesh</option>
<option>Maharashtra</option>
<option>Manipur</option>
<option>Meghalaya</option>
<option>Mizoram</option>
<option>Nagaland</option>
<option>Odisha</option>
<option>Punjab</option>
<option>Puducherry</option>
<option>Rajsthan</option>
<option>Sikkim</option>
<option>Tamil Nadu</option>
<option>Telangana</option>
<option>Uttar Pradesh</option>
<option>Uttarakhand</option>
<option>West bengal</option>
</select>
<div class="invalid-feedback">
Please provide a valid state.
</div>
</div>
<div class="col-md-3 mb-3">
<label for="zip">Zip<span class="text-muted">*</span></label>
<input type="text" class="form-control" id="zip" placeholder="" required>
<div class="invalid-feedback">
Zip code required.
</div>
</div>
</div>
<hr class="mb-4">
<h4 class="mb-3">Gender</h4>
<div class="d-block my-3">
<div class="custom-control custom-radio">
<input id="credit" name="paymentMethod" type="radio" class="custom-control-input" checked required>
<label class="custom-control-label" for="credit">Male</label>
</div>
<div class="custom-control custom-radio">
<input id="debit" name="paymentMethod" type="radio" class="custom-control-input" required>
<label class="custom-control-label" for="debit">Female</label>
</div>
<div class="custom-control custom-radio">
<input id="paypal" name="paymentMethod" type="radio" class="custom-control-input" required>
<label class="custom-control-label" for="paypal">Other</label>
</div>
</div>
<hr class="mb-4">
<button class="btn btn-primary btn-lg btn-block " type="submit">Submit</button>
</form>
</div>
<!-- ******************************* footer ******************************************************* -->
<footer id ="Contact" class="footer mt-5"><div class="container-fluid bg-dark">
<h2 class="display-4 lead-dark">More Info</h2>
<hr>
<a id="icons" href="https://www.instagram.com/mygovindia/" class="fa fa-instagram ml-3"></a>
<a id="icons" href="https://twitter.com/mygovindia" class="fa fa-twitter ml-3"></a>
<a id="icons" href="https://www.facebook.com/MyGovIndia/" class="fa fa-facebook ml-3"></a>
<a id="icons" href="#" class="fa fa-envelope ml-3"></a>
<p id="copyright">© Copyright 2020</p>
</div></footer></div>
<!-- Bootstrap core JavaScript
================================================== -->
<!-- Placed at the end of the document so the pages load faster -->
<script src="https://code.jquery.com/jquery-3.3.1.slim.min.js" integrity="sha384-q8i/X+965DzO0rT7abK41JStQIAqVgRVzpbzo5smXKp4YfRvH+8abtTE1Pi6jizo" crossorigin="anonymous"></script>
<script>window.jQuery || document.write('<script src="../../assets/js/vendor/jquery-slim.min.js"><\/script>')</script>
<script src="../../assets/js/vendor/popper.min.js"></script>
<script src="../../dist/js/bootstrap.min.js"></script>
<script src="../../assets/js/vendor/holder.min.js"></script>
<script>
// Example starter JavaScript for disabling form submissions if there are invalid fields
(function() {
'use strict';
window.addEventListener('load', function() {
// Fetch all the forms we want to apply custom Bootstrap validation styles to
var forms = document.getElementsByClassName('needs-validation');
// Loop over them and prevent submission
var validation = Array.prototype.filter.call(forms, function(form) {
form.addEventListener('submit', function(event) {
if (form.checkValidity() === false) {
event.preventDefault();
event.stopPropagation();
}
form.classList.add('was-validated');
}, false);
});
}, false);
})();
</script>
<!-- Optional JavaScript -->
<!-- jQuery first, then Popper.js, then Bootstrap JS -->
<script src="https://code.jquery.com/jquery-3.3.1.slim.min.js" integrity="sha384-q8i/X+965DzO0rT7abK41JStQIAqVgRVzpbzo5smXKp4YfRvH+8abtTE1Pi6jizo" crossorigin="anonymous"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/popper.js/1.14.3/umd/popper.min.js" integrity="sha384-ZMP7rVo3mIykV+2+9J3UJ46jBk0WLaUAdn689aCwoqbBJiSnjAK/l8WvCWPIPm49" crossorigin="anonymous"></script>
<script src="https://stackpath.bootstrapcdn.com/bootstrap/4.1.3/js/bootstrap.min.js" integrity="sha384-ChfqqxuZUCnJSK3+MXmPNIyE6ZbWh2IMqE241rYiqJxyMiZ6OW/JmZQ5stwEULTy" crossorigin="anonymous"></script>
</body>
</html>