@extends('layouts.v2.frontend-user-backend')

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

@section('content')
@include('frontend.forms.v2.End-Of-Life-Plan.stepIndicator')
    <form action="{{route('EndoflifePlanFormStore')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="4-4-4-1">
      <div class="multiple-form dashboard-radio">
         <h4>Who will receive your ashes?</h4>
         <p></p>
         <div class="form">
            <div class="row">
               <div class="col-12">
                  <div id="receive_your_ashes" class="child-card-holder">
                     @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 => $receive_your_ashes)
                        <div class="card list mb-3" id="child">
                           <div class="card-header">
                              <div class="card-title m-0">Recipient</div>
                              <a class="r-button" onclick="removetList(this)">
                              <span class="fas fa-times"></span>
                              <span class="remove">Remove</span>
                              </a>
                           </div>
                           <div class="card-body">
                              <div class="form-group mb-3">
                                 <label for="name">Name:</label>
                                 <input type="text"  name="full_name[]" id="full_name__{{$index}}"  value="{{$receive_your_ashes['full_name']}}">
                              </div>
                              <div class="form-group mb-3">
                                 <label for="name">Relationship:</label>
                                 <input type="text"  name="relationship[]" id="relationship_{{$index}}" value="{{$receive_your_ashes['relationship']}}">
                              </div>
                              <div class="form-group mb-3">
                                 <label for="city">Address :</label>
                                 <input type="text"  name="address[]" id="address_{{$index}}"  value="{{$receive_your_ashes['address']}}">
                                 <small id="cityHelp" class="form-text text-muted d-none">e.g. Street, City, State ZIP Code</small>
                              </div>
                              <div class="form-group mb-3">
                                 <label for="phone_number">Phone number :</label>
                                 <input type="text" name="phone[]" id="phone_{{$index}}"  value="{{$receive_your_ashes['phone']}}"  >
                              </div>
                              <div class="form-group mb-3">
                                 <label for="email">Email :</label>
                                 <input type="text"  name="email[]" id="email_{{$index}}"  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"  name="full_name[]" id="full_name">
                              </div>
                              <div class="form-group mb-3">
                                 <label for="name">Relationship:</label>
                                 <input type="text"  name="relationship[]" id="relationship">
                              </div>
                              <div class="form-group mb-3">
                                 <label for="city">Address :</label>
                                 <input type="text" class="form-control modified-input remove_space" name="address[]" id="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" name="phone[]" id="phone"  >
                              </div>
                              <div class="form-group mb-3">
                                 <label for="email">Email :</label>
                                 <input type="text"  name="email[]" id="email">
                              </div>
                           </div>
                        </div>
                     @endif
                  </div>
                  <div class="add-child">
                     <a href="#" class="add-another" id="add-another-child" onclick="clone('receive_your_ashes')" class="add-button">Add another recipient</a>
                  </div>
               </div>
            </div>
         </div>
         <!-- start previous / next buttons -->
         <div id="buttonsection" class="submit-button-multiple">  
            @if($endoflifePlanForm->cremation == 'loved' || $endoflifePlanForm->cremation == "burial" || $endoflifePlanForm->cremation == "columbarium")
               <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.four_4_2') }}'">Back</button>
            @else
               <button type="button" onclick="window.location.href = '{{ route('endoflifePlan.create.step.four_4_1') }}'">Back</button>
            @endif
            <button type="submit" class="submit-btn">Save and Continue</button>
            <button type="submit" class="d-none" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
            <button type="button" class="skip-btn d-none">Skip Step</button>
         </div>
         <!-- end previous / next buttons -->
      </div>
    </form>	  
@endsection
@section('page-js')
   <script src="{{ url('frontend/assets/js/forms/end-of-life-plan-multi-step.js') }}?v={{ time() }}"></script>
   <script src="{{ url('frontend/assets/js/forms/custom.js?v=10.3') }}"></script>
   <script src="{{ url('v2/js/form-validation.js') }}?v={{ time() }}"></script>

@endsection