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form.php
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form.php
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<!DOCTYPE html>
<html>
<head>
<title>The Jagriti Project</title>
</head>
<link rel="stylesheet" href="css/main.css"/>
<link rel="stylesheet" href="css/bootstrap.min.css"/>
<link rel="stylesheet" href="css/bootstrap-theme.min.css"/>
<link href='http://fonts.googleapis.com/css?family=Open+Sans:400,300,100' rel='stylesheet' type='text/css'>
<link href='http://fonts.googleapis.com/css?family=Raleway:100,300' rel='stylesheet' type='text/css'>
<script src="js/jquery-1.8.3.min.js"></script>
<script src="js/bootstrap.min.js"></script>
<script src="js/main.js"></script>
<script src="js/formValidation.js"></script>
<body>
<div id="main-container">
<div id="menu" class="row">
<a href="http://blog.projectjagriti.org"><div class="col-md-2">Blog</div></a>
<a href="aboutus.html"><div class="col-md-2">About Us</div></a>
<a href="index.html"><div class="col-md-4" id="logo" data-goto="1"><img src="img/logo.png"/></div></a>
<a href="ourpartners.html"><div class="col-md-2">Our Partners</div></a>
<a href="contactus.html"><div class="col-md-2">Contact Us</div></a>
</div>
<div class="accent" style="margin:auto auto; width:720px;">
Thank you for your interest shown in The Jagriti Project.</br>
Please fill in the form given below, and your complaint will be registered. We assure you, those children WILL be helped.
<!--
<form>
</br><li>Cateogry of Report<br></li>
<input type="checkbox" name="complaint" value"child_abuse"> Child Abuse<br>
<input type="checkbox" name="complaint" value"child_labour"> Child Labour<br>
<input type="checkbox" name="complaint" value"child_prostitution"> Child Prostitution<br>
<input type="checkbox" name="complaint" value"other"> Other<br>
</form>
-->
<form enctype="multipart/form-data" name="submit_form" onsubmit="return validateForm();" method="post" action="php/verify.php" >
<ol>
<br><li>Address of Location</li><br/>
<textarea name="address" placeholder="Enter Address"></textarea>
<br/>
<br><li>Email ID</li>
<input type="text" placeholder="Your email address" name="email"><br><br/>
<li>
Broad Category of Complaint (Select multiple boxes if necessary)
</li><br/>
<input type="checkbox" name="category[]" value="Physical Abuse"> Physical Abuse<br>
<input type="checkbox" name="category[]" value="Sexual Abuse"> Sexual Abuse<br>
<input type="checkbox" name="category[]" value="Emotional Abuse"> Emotional Abuse<br>
<input type="checkbox" name="category[]" value="Neglect"> Neglect<br>
<input type="checkbox" name="category[]" value="Child Marriage"> Child Marriage<br>
<input type="checkbox" name="category[]" value="Child Prostitution"> Child Prostitution<br>
<input type="checkbox" name="category[]" value="Child Exploitation"> Child Exploitation<br>
<input type="checkbox" name="category[]" value="Child Labour"> Child Labour<br>
<br/>
<li>
Description
</li>
<textarea name="description" placeholder="Any description that will help us"></textarea>
<br/>
</ol>
<br/>
<h3>Optional Details</h3><br/>
These will help us contact you, if we have any questions related to your report and/or to inform you of the status of your report. We will do so only if you wish to be contacted.
<ol>
<br/>
<li>
Name
</li>
<input type="text" name="name"><br/>
<br/>
<li>
Contact Number
</li>
<input type="text" name="number"><br/>
<br/>
<li>
Add Photo (Adding photo increases the effectiveness of the complaint)<br/><br/>
</li>
<input type="file" name="file" id="file">
</ol>
<?php
require_once('php/recaptchalib.php');
$publickey = "6Leuiu8SAAAAAMNC1-PTWyZa_rMo3XozPEy7rljX"; // you got this from the signup page
echo recaptcha_get_html($publickey);
?>
<br/><br/>
<div style="margin:auto auto; width:100%; padding-left:40%;">
<input type="submit" name="submit" value="Submit Form">
<br/>
<br/>
<br/>
</div>
</form>
</div>
</div>
</body>
</html>