IMMREX7
<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<title>Admission Form</title>
<style>
@page {
margin: 55px;
background: #4c1f4c;
}
body {
font-family: Arial, sans-serif;
font-size: 13px;
margin: 0;
}
.logo {
position: absolute;
left: 0; top: 0;
width: 150px; height: 150px;
text-align: center; font-size: 11px;
}
.form-container {
border-radius: 50px;
padding: 20px 30px;
background: #fff;
min-height: 250mm;
box-sizing: border-box;
position: relative;
line-height: 1.3
}
.top-row-box {
border: 1px solid #000;
border-radius: 15px;
padding: 8px 12px;
margin-bottom: 15px;
}
.photo-box {
border: 1px solid #000;
width: 120px;
height: 110px;
}
</style>
</head>
<body>
<!-- PAGE 1 -->
<div class="page-border">
<div class="form-container">
<div class="top-row-box">
<table style="width:100%">
<tr>
<td style="width:8%;">Standard : </td>
<td style="border-bottom:1px solid black;width:15%;text-align: center;"> <?php echo e($class->className); ?></td>
<td style="width:8%;">Year : </td>
<td style="border-bottom:1px solid black;width:15%;text-align: center;"> <?php echo e($financialYear->financialYearName); ?></td>
<td style="width:14%;">G.R. / U.I.D. No. : </td>
<td style="border-bottom:1px solid black;width:20%;"> </td>
</tr>
</table>
</div>
<table class="width:100%;border-collapse: collapse;vertical-align: top;">
<tr>
<td colspan="3">
<img src="<?php echo e(asset('storage/schools/' . $school->idSchool . '/' . $school->schoolLogo)); ?>" class="logo">
</td>
<td colspan="3">
<img src="<?php echo e(asset('storage/calendar/school.png')); ?>" style="height:150px;">
</td>
<td rowspan="2" style="vertical-align: bottom;">
<?php if(isset($reg_student->photo)): ?>
<img src="<?php echo e(asset('storage/schools/'.$school->idSchool.'/onlinereg/'.$reg_student->photo)); ?>" height="120" width="120">
<?php else: ?>
<img src="<?php echo e(asset('storage/calendar/photo.png')); ?>" style="height:120px;">
<?php endif; ?>
</td>
</tr>
<tr>
<td colspan="5" style="padding-top: 15px;"></td>
<td style="padding-top: 15px;"></td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;">
<tr>
<td style="width: 10%;"><b>Sr. No. : </b></td>
<td style="width: 15%;border-bottom:1px solid black;"> <?php echo e(strtoupper(str_replace("REGM.J ","",$reg_student->registrationNo))); ?></td>
<td style="width: 25%;"></td>
<td style="width: 8%;"><b>Date : </b></td>
<td style="width: 20%;border-bottom:1px solid black;"> <?php if(isset($reg_student->studentDob)): ?> <?php echo e(\Carbon\Carbon::now()->format('d/m/Y')); ?> <?php endif; ?></td>
<td style="width: 2%;"></td>
<td style="width: 15%;">
</td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:20px;">
<tr>
<td style="width: 20%;">1. Name of the Pupil :</td>
<td style="width: 20%;border-bottom:1px solid black;"> </td>
<td style="width: 20%;border-bottom:1px solid black;"><?php if(isset($reg_student->firstName)): ?>
<?php echo e(strtoupper($reg_student->firstName)); ?>
<?php endif; ?> <?php if(isset($reg_student->middleName)): ?>
<?php echo e(strtoupper($reg_student->middleName)); ?>
<?php endif; ?> <?php if(isset($reg_student->lastName)): ?>
<?php echo e(strtoupper($reg_student->lastName)); ?>
<?php endif; ?> </td>
<td style="width: 25%;border-bottom:1px solid black;text-align: center;"><?php if(isset($reg_student->father_fname)): ?>
<?php echo e(strtoupper($reg_student->father_fname)); ?>
<?php endif; ?>
<?php if(isset($reg_student->father_lname)): ?>
<?php echo e(strtoupper($reg_student->father_lname)); ?>
<?php endif; ?> </td>
</tr>
<tr>
<td style="width: 15%;"></td>
<td style="width: 25%;text-align: center;"><small>(Surname)</small></td>
<td style="width: 25%;text-align: center;"><small>(Name)</small></td>
<td style="width: 25%;text-align: center;"><small> (Father’s Name)</small></td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 25%;">2. Father’s Full Name :</td>
<td style="width: 29%;border-bottom:1px solid black;"><?php if(isset($reg_student->father_fname)): ?>
<?php echo e(strtoupper($reg_student->father_fname)); ?>
<?php endif; ?>
<?php if(isset($reg_student->father_lname)): ?>
<?php echo e(strtoupper($reg_student->father_lname)); ?>
<?php endif; ?> </td>
<td style="width: 8%;">Qualification : </td>
<td style="width: 32%;border-bottom:1px solid black;"> <?php if(isset($reg_student->father_occupation)): ?>
<?php echo e(strtoupper($reg_student->father_occupation)); ?>
<?php endif; ?></td>
</tr>
<tr>
<td style="width: 25%;padding-top: 18px;">3. Mother’s Name :</td>
<td style="width: 29%;border-bottom:1px solid black;padding-top: 18px;"><?php if(isset($reg_student->mother_fname)): ?>
<?php echo e(strtoupper($reg_student->mother_fname)); ?>
<?php endif; ?>
<?php if(isset($reg_student->mother_lname)): ?>
<?php echo e(strtoupper($reg_student->mother_lname)); ?>
<?php endif; ?> </td>
<td style="width: 8%;padding-top: 18px;">Qualification : </td>
<td style="width: 32%;border-bottom:1px solid black;padding-top: 18px;"><?php if(isset($reg_student->mother_occupation)): ?>
<?php echo e(strtoupper($reg_student->mother_occupation)); ?>
<?php endif; ?> </td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 18%;">4. Mother Tongue :</td>
<td style="width: 31%;border-bottom:1px solid black;"> <?php if(isset($reg_student->motherTounge)): ?>
<?php echo e(strtoupper($reg_student->motherTounge)); ?>
<?php endif; ?></td>
<td style="width: 20%;">Gender (Male/Female) : </td>
<td style="width: 24%;border-bottom:1px solid black;"> <?php if(isset($reg_student->gender)): ?>
<?php echo e(strtoupper($reg_student->gender)); ?>
<?php endif; ?></td>
</tr>
<tr>
<td style="width: 18%;padding-top: 18px;">5. Religion :</td>
<td style="width: 31%;border-bottom:1px solid black;padding-top: 18px;"> <?php if(isset($reg_student->religion)): ?>
<?php echo e(strtoupper($reg_student->religion)); ?>
<?php endif; ?></td>
<td style="width: 20%;padding-top: 18px;">6. Nationality : </td>
<td style="width: 24%;border-bottom:1px solid black;padding-top: 18px;"> <?php if(isset($reg_student->nationality)): ?>
<?php echo e(strtoupper($reg_student->nationality)); ?>
<?php endif; ?></td>
</tr>
<tr>
<td style="width: 18%;padding-top: 18px;">7. Caste :</td>
<td style="width: 31%;border-bottom:1px solid black;padding-top: 18px;"><?php if(isset($reg_student->caste)): ?>
<?php echo e(strtoupper($reg_student->caste)); ?>
<?php endif; ?> </td>
<td style="width: 20%;padding-top: 18px;">Sub-Caste (If Any) : </td>
<td style="width: 24%;border-bottom:1px solid black;padding-top: 18px;"> </td>
</tr>
<tr>
<td style="width: 18%;"></td>
<td style="width: 31%;"> </td>
<td style="width: 44%;" colspan="2"><small>(For the pupils other than open category)</small></td>
</tr>
</table>
<?php
$bday = new DateTime($reg_student->studentDob);
$today = new DateTime(date('y-m-d'));
$diff = $today->diff($bday);
$dob = \Carbon\Carbon::parse($reg_student->studentDob)->format('d.F.Y');
$pieces = explode(".", $dob);
?>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 20%;">8. Date of Birth :</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"><?php if(isset($reg_student->studentDob)): ?> <?php echo e(\Carbon\Carbon::parse($reg_student->studentDob)->format('d')); ?> <?php endif; ?></td>
<td style="width: 2%;">/</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"><?php if(isset($reg_student->studentDob)): ?> <?php echo e(\Carbon\Carbon::parse($reg_student->studentDob)->format('m')); ?> <?php endif; ?></td>
<td style="width: 2%;">/</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"><?php if(isset($reg_student->studentDob)): ?> <?php echo e(\Carbon\Carbon::parse($reg_student->studentDob)->format('Y')); ?> <?php endif; ?></td>
<td style="width: 4%;"></td>
<td style="width: 34%;border-bottom:1px solid black;text-align: center;"> <?php if(count($pieces) > 1): ?> <?php echo e(str_replace("only","",figToWordDob($pieces[0]))); ?> <?php echo e($pieces[1]); ?> <?php echo e(str_replace("only","",figToWordDob($pieces[2]))); ?> <?php endif; ?></td>
</tr>
<tr>
<td style="width: 20%;"></td>
<td style="width: 8%;text-align: center;">DD</td>
<td style="width: 2%;"></td>
<td style="width: 8%;text-align: center;">MM</td>
<td style="width: 2%;"></td>
<td style="width: 8%;text-align: center;">YY</td>
<td style="width: 4%;"></td>
<td style="width: 54%;text-align: center;"><small>(in words)</small></td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 20%;">9. Aadhar Card No. :</td>
<td style="width: 25%;border-bottom:1px solid black;"><?php if(isset($reg_student->aadhaarNo)): ?>
<?php echo e(strtoupper($reg_student->aadhaarNo)); ?>
<?php endif; ?> </td>
<td style="width: 10%;">10. Age :</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"> <?php if(isset($diff->y)): ?> <?php echo e($diff->y); ?> <?php endif; ?></td>
<td style="width: 8%;">Years</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"> <?php if(isset($diff->m)): ?> <?php echo e($diff->m); ?> <?php endif; ?></td>
<td style="width: 8%;">Months</td>
<td style="width: 8%;border-bottom:1px solid black;text-align: center;"> <?php if(isset($diff->d)): ?> <?php echo e($diff->d); ?> <?php endif; ?></td>
<td style="width: 8%;">Days</td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 20%;">11. Place of Birth :</td>
<td style="width: 25%;border-bottom:1px solid black;"> <?php if(isset($reg_student->studentPob)): ?>
<?php echo e(strtoupper($reg_student->studentPob)); ?>
<?php endif; ?> </td>
<td style="width: 25%;">12. Blood Group of Pupil : </td>
<td style="width: 25%;border-bottom:1px solid black;"> <?php if(isset($reg_student->bloodGroup)): ?>
<?php echo e(strtoupper($reg_student->bloodGroup)); ?>
<?php endif; ?> </td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 35%;">13. Last School Attended (If Any):</td>
<td style="width: 65%;border-bottom:1px solid black;"> <?php if(isset($reg_student->lastSchool)): ?>
<?php echo e(strtoupper($reg_student->lastSchool)); ?>
<?php endif; ?> </td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 40%;">14. Reason of Leaving the Last School:</td>
<td style="width: 60%;border-bottom:1px solid black;"><?php if(isset($reg_student->reasonForChange)): ?>
<?php echo e(strtoupper($reg_student->reasonForChange)); ?>
<?php endif; ?> </td>
</tr>
<tr>
<td style="border-bottom:1px solid black;padding-top: 30px;" colspan="2"> </td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 25%;">15. Address :</td>
<td style="width: 75%;border-bottom:1px solid black;"> <?php if(isset($reg_student->resAddress)): ?>
<?php echo e(strtoupper($reg_student->resAddress)); ?>
<?php endif; ?> </td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 65%;border-bottom:1px solid black;"><?php if(isset($reg_student->resCity)): ?>
<?php echo e(strtoupper($reg_student->resCity)); ?>
<?php endif; ?>
<?php if(isset($reg_student->landmark)): ?>
<?php echo e(strtoupper($reg_student->landmark)); ?>
<?php endif; ?> <?php if(isset($reg_student->resState)): ?>
<?php echo e(strtoupper(DB::table('states')->where('idState',$reg_student->resState)->first()->stateName)); ?>
<?php endif; ?> </td>
<td style="width: 18%;">Pin Code : </td>
<td style="width: 17%;border-bottom:1px solid black;"> <?php if(isset($reg_student->resPincode)): ?>
<?php echo e(strtoupper($reg_student->resPincode)); ?>
<?php endif; ?></td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;margin-top:18px;">
<tr>
<td style="width: 25%;">16. Phone No. :</td>
<td style="width: 29%;border-bottom:1px solid black;"> <?php if(isset($reg_student->father_mobile)): ?>
<?php echo e(strtoupper($reg_student->father_mobile)); ?>
<?php endif; ?></td>
<td style="width: 8%;">(Off.) </td>
<td style="width: 32%;border-bottom:1px solid black;"> </td>
</tr>
<tr>
<td style="width: 25%;padding-top: 18px;">17. Mobile :(Father)</td>
<td style="width: 29%;border-bottom:1px solid black;padding-top: 18px;"> <?php if(isset($reg_student->father_mobile)): ?>
<?php echo e(strtoupper($reg_student->father_mobile)); ?>
<?php endif; ?></td>
<td style="width: 8%;padding-top: 18px;">(Mother): </td>
<td style="width: 32%;border-bottom:1px solid black;padding-top: 18px;"> <?php if(isset($reg_student->mother_mobile)): ?>
<?php echo e(strtoupper($reg_student->mother_mobile)); ?>
<?php endif; ?></td>
</tr>
<tr>
<td style="width: 25%;"></td>
<td style="width: 29%;padding-top:10px;text-align: center;"><small>SMS Preferred</small> ☐</td>
<td style="width: 8%;"></td>
<td style="width: 32%;padding-top:10px;text-align: center;"><small>SMS Preferred</small> ☐</td>
</tr>
</table>
<table style="width:100%; border-collapse: collapse;vertical-align: middle;">
<tr>
<td style="width: 25%;padding-top: 18px;">18. Email :(Father)</td>
<td style="width: 29%;border-bottom:1px solid black;padding-top: 18px;"><?php if(isset($reg_student->father_email)): ?>
<?php echo e(strtoupper($reg_student->father_email)); ?>
<?php endif; ?> </td>
<td style="width: 8%;padding-top: 18px;">(Mother): </td>
<td style="width: 32%;border-bottom:1px solid black;padding-top: 18px;"><?php if(isset($reg_student->mother_email)): ?>
<?php echo e(strtoupper($reg_student->mother_email)); ?>
<?php endif; ?> </td>
</tr>
</table>
</div>
</div>
<pagebreak />
<!-- PAGE 2 : Declaration -->
<div class="form-container">
<h2 style="text-align:center; text-decoration:underline; margin-bottom:20px; font-weight: bold">
DECLARATION
</h2>
<ol style="line-height:1.8; margin-left:20px; font-weight: bold">
<li>The birth date of my ward as entered by me in admission form is true and correct and is entered on the authority of the Hospital / Municipal Birth Certificate.</li>
<li>I certify that the details mentioned in this form are true.</li>
<li>I hereby agree to abide by the rules & regulations of the school intimated time to time.</li>
<li>Are you interested in availing bus facility - Yes / No</li>
</ol>
<div style="margin-top:80px; text-align:right; padding-right:40px;">
<span style="font-size:13px; font-weight: bold;border-top:1px solid black;">Signature of Parent / Legal Guardian</span>
</div>
<div class="top-row-box" style="margin-top: 460px;">
<table style="width:100%">
<tr>
<td colspan="4" style="text-align: center;font-size:20px;"><b><u>FOR OFFICE USE ONLY</u></b></td>
</tr>
<tr>
<td style="width:25%;padding-top: 28px;"><b>Standard and Division :</b> </td>
<td style="border-bottom:1px solid black;width:25%"> </td>
<td style="width:20%;padding-top: 28px;"><b>Admission Date :</b> </td>
<td style="border-bottom:1px solid black;width:25%"> </td>
</tr>
<tr>
<td style="padding-top: 58px;"><b>Class Teacher :</b> </td>
<td style="border-bottom:1px solid black;"> </td>
<td style="padding-top: 58px;"><b>Head Mistress :</b> </td>
<td style="border-bottom:1px solid black;"> </td>
</tr>
</table>
</div>
</div>
</div>
</body>
</html>
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