@extends('layouts.frontend')

@section('title', '| FREE END-OF-LIFE PLAN')

@section('content')
@include('frontend.forms.End-Of-Life-Plan.stepIndicator')
 <!-- start -->
<div class="container">
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="4-4-4-1">
      <div class="card">
         <div class="card-body">
            <!-- step 1 -->
            <div class="step" style="display: block">
               <div class="row">
                  <div class="col-md-8">
                     <div class="card-title">Who will receive your ashes?</div>
                        <div id="receive_your_ashes">
                           @php
                           $receive_your_ashesArray = json_decode($endoflifePlanForm->receive_your_ashes, true)
                           @endphp
                           @if(!empty($endoflifePlanForm->receive_your_ashes) && count($receive_your_ashesArray) > 0)                                 
                              @foreach($receive_your_ashesArray as $index => $receive_your_ashes)
                              <div class="card list mb-3" id="child">
                                 <div class="card-header d-flex justify-content-between">
                                    <div class="card-title m-0">Recipient</div>
                                    <a class="r-button" onclick="removetList(this)">
                                    <span class="fas fa-times"></span>
                                    <span class="remove">Remove</span>
                                    </a>
                                 </div>
                                 <div class="card-body">
                                    <div class="form-group mb-3">
                                       <label for="name">Name:</label>
                                       <input type="text" class="form-control modified-input" name="full_name[]" id="full_name" placeholder="Full Name" value="{{$receive_your_ashes['full_name']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="name">Relationship:</label>
                                       <input type="text" class="form-control modified-input" name="relationship[]" id="relationship" placeholder="Relationship" value="{{$receive_your_ashes['relationship']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="city">Address :</label>
                                       <input type="text" class="form-control modified-input" name="address[]" id="address"  placeholder="Address" value="{{$receive_your_ashes['address']}}">
                                       <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="phone_number">Phone Number :</label>
                                       <input type="text" class="form-control modified-input" name="phone[]" id="phone_number" placeholder="Phone Number " value="{{$receive_your_ashes['phone']}}">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="email">Email :</label>
                                       <input type="text" class="form-control modified-input" name="email[]" id="email" placeholder="Email " value="{{$receive_your_ashes['email']}}">
                                    </div>
                                 </div>
                              </div>
                              @endforeach
                           @else                          
                              <div class="card list mb-3" id="child">
                                 <div class="card-header d-flex justify-content-between">
                                    <div class="card-title m-0">Recipient</div>
                                    <a class="r-button" onclick="removetList(this)">
                                    <span class="fas fa-times"></span>
                                    <span class="remove">Remove</span>
                                    </a>
                                 </div>
                                 <div class="card-body">
                                    <div class="form-group mb-3">
                                       <label for="name">Name:</label>
                                       <input type="text" class="form-control modified-input" name="full_name[]" id="full_name" placeholder="Full Name">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="name">Relationship:</label>
                                       <input type="text" class="form-control modified-input" name="relationship[]" id="relationship" placeholder="Relationship">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="city">Address :</label>
                                       <input type="text" class="form-control modified-input" name="address[]" id="address"  placeholder="Address">
                                       <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="phone_number">Phone Number :</label>
                                       <input type="text" class="form-control modified-input" name="phone[]" id="phone_number" placeholder="Phone Number ">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="email">Email :</label>
                                       <input type="text" class="form-control modified-input" name="email[]" id="email" placeholder="Email ">
                                    </div>
                                 </div>
                              </div>
                           @endif
                        </div>
                     <div class="add-child">
                        <a href="#" id="add-another-child" onclick="clone('receive_your_ashes')" class="add-button"><span class="fas fa-plus"></span>Add another recipient</a>
                     </div>
                  </div>
               </div>
            </div>
            <!-- start previous / next buttons -->
            <div id="buttonsection">
               <div class="form-footer d-flex justify-content-between">
                  <div>
                     
                  @if($endoflifePlanForm->cremation == 'loved' || $endoflifePlanForm->cremation == "burial" || $endoflifePlanForm->cremation == "columbarium")
                     <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.four_4_2') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  @else
                     <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.four_4_1') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  @endif
                  <button type="submit" class="btn btn-light btn-lg">Save and Continue</button>
               </div>
               <button type="submit" class="btn btn-light btn-lg" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
                  <button type="button" class="btn btn-light btn-lg skip-btn d-none">Skip Step</button>
               </div>
            </div>
            <!-- end previous / next buttons -->
         </div>
      </div>
</div>

@endsection
@section('page-js')
<script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js?v=10.1.1') }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>

@endsection