@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="3-3-3">
      <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">Obituary Details</div>
                     <div class="card-sub-title">Would you like to include a photograph?</div>
                     <div class="custom-button-yn">
                        <input id="obituary_photograph-y" name="obituary_photograph" value="yes" type="radio" {{!isset($endoflifePlanForm->obituary_death_notice_photograph) || $endoflifePlanForm->obituary_death_notice_photograph == 'yes' ? 'checked' : ''}}>
                        <label for="obituary_photograph-y">Yes</label>
                        <input id="obituary_photograph-n" name="obituary_photograph" value="no" type="radio" {{isset($endoflifePlanForm->obituary_death_notice_photograph) && $endoflifePlanForm->obituary_death_notice_photograph == 'no' ? 'checked' : ''}}>
                        <label for="obituary_photograph-n">No</label>
                     </div>
                     <div class="form-group mb-5 mt-5" id="obituary_photograph_details">
                        <label for="Name">Describe the photograph you wish to include and where it can be found:</label>
                        <input value="{{isset($endoflifePlanForm->obituary_photograph_details) ? $endoflifePlanForm->obituary_photograph_details : ''}}" type="text" class="form-control modified-input" name="obituary_photograph_details">
                        <small id="nameHelp" class="form-text text-muted">e.g. I would like the photo of me wearing overalls in the garden to be used. It can be found in my photo album collection.</small>
                     </div>
                     <div class="card-sub-title">Would you like to include funeral or other service details?</div>
                     <div class="custom-button-yn">
                        <input id="obituary_funeral_service-y" name="obituary_funeral_service" value="yes" type="radio" {{isset($endoflifePlanForm->obituary_funeral_service) && $endoflifePlanForm->obituary_funeral_service == 'yes' ? 'checked' : ''}}>
                        <label for="obituary_funeral_service-y">Yes</label>
                        <input id="obituary_funeral_service-n" name="obituary_funeral_service" value="no" type="radio" {{!isset($endoflifePlanForm->obituary_funeral_service) || $endoflifePlanForm->obituary_funeral_service == 'no' ? 'checked' : ''}}>
                        <label for="obituary_funeral_service-n">No</label>
                     </div>
                     <div class="card-sub-title">Would you like to request charitable donations instead of flowers?</div>
                     <div class="custom-button-yn mb-5">
                        <input id="obituary_charitable-y" name="obituary_charitable" value="yes" type="radio" {{!isset($endoflifePlanForm->obituary_charitable_donations) || $endoflifePlanForm->obituary_charitable_donations == 'yes' ? 'checked' : ''}}>
                        <label for="obituary_charitable-y">Yes</label>
                        <input id="obituary_charitable-n" name="obituary_charitable" value="no" type="radio" {{isset($endoflifePlanForm->obituary_charitable_donations) && $endoflifePlanForm->obituary_charitable_donations == 'no' ? 'checked' : ''}}>
                        <label for="obituary_charitable-n">No</label>
                     </div>
                     <div id="obituary_charitable_main">
                        <div id="obituary_charitable_holder">
                           @if(!empty($endoflifePlanForm->obituary_charitable_details))                                 
                           @foreach(json_decode($endoflifePlanForm->obituary_charitable_details, true) as $index => $obituary_charitable)
                              <div class="card list mb-3" id="child">
                                 <div class="card-header d-flex justify-content-between">
                                    <div class="card-sub-title m-0">Charity</div>
                                    <a class="r-button" onclick="removetList(this)">
                                       <span class="fas fa-times"></span>
                                       <span class="remove">Remove</span>
                                    </a>
                                 </div>
                                 <div class="card-body">
                                    <div class="form-group mb-3">
                                       <label for="Name">Full Name of Charity:</label>
                                       <input value="{{$obituary_charitable['charity_name']}}" type="text" class="form-control modified-input" name="charity[]">
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="Name">Registration number:</label>
                                       <input value="{{$obituary_charitable['registration_number']}}" type="text" class="form-control modified-input" name="registration_number[]">
                                       <small id="nameHelp" class="form-text text-muted">e.g. 20-0583415</small>
                                    </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-sub-title m-0">Charity</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="card-body">
                                       <div class="form-group mb-3">
                                          <label for="Name">Full Name of Charity:</label>
                                          <input  type="text" class="form-control modified-input" name="charity[]">
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="Name">Registration number:</label>
                                          <input  type="text" class="form-control modified-input" name="registration_number[]">
                                          <small id="nameHelp" class="form-text text-muted">e.g. 20-0583415</small>
                                       </div>
                                    </div>
                                 </div>
                              </div>
                           @endif
                        </div>
                        <div class="add-child">
                           <a href="#" id="add-obituary-button" onclick="clone('obituary_charitable_holder')">
                           <span class="fas fa-plus"></span>Add another charity</a>
                        </div>
                     </div>
                  </div>
               </div>
            </div>
            <!-- start previous / next buttons -->
            <div id="buttonsection">
               <div class="form-footer d-flex justify-content-between">
                  <div>
                  <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.three_3_2') }}'" class="btn btn-light btn-lg back-btn">Back</button>
                  <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