« 回覆文章 #2 於: 三月 10, 2016, 01:49:24 pm »
<div class="container">
<div class="row text-center">
<div class="col-xs-12 col-md-10 col-md-offset-1">
<div class="alert alert-success" role="alert">
<form class="form-horizontal" method="POST" action="checkpwd.php">
<div class="form-group">
<label for="input1" class="col-sm-2 control-label">*使用者帳號:</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="input1" value="<?php echo $S['account'] ?>" disabled="ture">
</div>
</div>
<div class="form-group">
<label for="input2" class="col-sm-2 control-label">*姓名:</label>
<div class="col-sm-4">
<input type="text" class="form-control" id="input2" value="<?php echo $S['username'] ?>" disabled="ture">
</div>
</div>
<div class="form-group">
<label for="datetimepicker1" class="col-sm-2 control-label">*出生日期:</label>
<div class="col-sm-4">
<div class='input-group date' id='datetimepicker1'>
<input type='text' class="form-control" />
<span class="input-group-addon">
<span class="glyphicon glyphicon-calendar"></span>
</span>
</div>
<script type="text/javascript">
$(function () {
$('#datetimepicker1').datetimepicker({
locale: 'zh-TW', format: 'YYYY-MM-DD'
});
});
</script>
</div>
</div>
<div class="form-group">
<label for="input4" class="col-sm-2 control-label">*聯絡電話:</label>
<div class="col-sm-4">
<input name="telephone" type="text" class="form-control" id="input4" size="20" placeholder="04-22226081" value="<?php echo $S['telephone'] ?>" >
</div>
</div>
<div class="form-group">
<label for="input5" class="col-sm-2 control-label">*聯絡手機:</label>
<div class="col-sm-4">
<input name="cellphone" type="text" class="form-control" id="input5" size="20" placeholder="09XX-123456" value="<?php echo $S['cellphone'] ?>" >
</div>
</div>
<div class="form-group">
<label for="input6" class="col-sm-2 control-label">*地址:</label>
<div class="col-sm-8">
<input name="address" type="text" class="form-control" id="input5" size="20" placeholder="404臺中市育才街2號" value="<?php echo $S['address'] ?>" >
</div>
</div>
<div class="form-group">
<label for="input7" class="col-sm-2 control-label">*就讀國中:</label>
<div class="col-sm-8">
<div class="form-inline">
<label class="radio-inline">
<input type="radio" name="st_1" value="1" <?php if ($S['st_1']==1) echo "checked"?>>應屆畢業生
</label>
<label class="radio-inline">
<input type="radio" name="st_1" value="0" <?php if ($S['st_1']==0) echo "checked"?>>縮短修業年限及升學辦法之國中生
</label>
</div>
<div class="form-inline">
<input type="text" name="st_cou" size="15" value="<?php echo $S['st_cou'] ?>">縣市(市)
<input type="text" name="school" size="20" value="<?php echo $S['school'] ?>">(全銜)
</div>
</div>
</div>
<div class="form-group">
<label for="input6" class="col-sm-2 control-label">*家長或監護人:</label>
<div class="col-sm-8">
<div class="form-group">
<label for="input9" class="col-sm-2 control-label">家長姓名:</label>
<div class="col-sm-8">
<input type="text" name="st_fa" value="<?php echo $S['st_fa'] ?>">
</div>
</div>
<div class="form-group">
<label for="input9" class="col-sm-2 control-label">關 係:</label>
<div class="col-sm-8">
<input type="text" name="st_rel" value="<?php echo $S['st_rel'] ?>">
</div>
</div>
<div class="form-group">
<label for="input9" class="col-sm-2 control-label">聯絡電話:</label>
<div class="col-sm-8">
<input type="text" name="st_fa_tel" value="<?php echo $S['st_fa_tel'] ?>">
</div>
</div>
<div class="form-group">
<label for="input9" class="col-sm-2 control-label">聯絡手機:</label>
<div class="col-sm-8">
<input type="text" name="st_fa_tel1" value="<?php echo $S['st_fa_tel1'] ?>">
</div>
</div>
</div>
</div>
<div class="form-group">
<label for="input7" class="col-sm-2 control-label">*身份別:</label>
<div class="col-sm-8">
<div class="form-inline">
<label class="radio-inline">
<input type="radio" name="st_8" value="1" <?php if ($S['st_8']==1) echo "checked"?>>一般生
</label>
<label class="radio-inline">
<input type="radio" name="st_8" value="2" <?php if ($S['st_8']==2) echo "checked"?>>身障生(請附證明)
</label>
<label class="radio-inline">
<input type="radio" name="st_8" value="1" <?php if ($S['st_8']==3) echo "checked"?>>低收入戶或中低收入戶子女(請附證明)
</label>
<label class="radio-inline">
<input type="radio" name="st_8" value="2" <?php if ($S['st_8']==4) echo "checked"?>>直系血親尊親屬支領失業給付者(請附證明)
</label>
</div>
</div>
</div>
<div class="form-group">
<label for="input6" class="col-sm-2 control-label">*錄取方式:<br>(請勾選)</label>
<div class="col-sm-10">
<div class="form-group">
<div class="col-sm-10 text-left">
<input type="checkbox" name="st_11" value="1" <?php if ($S['st_11']==1) echo "checked" ?> >逕送“直接錄取”審查。(請檢附證明文件,可加選科學能力檢定) <br>
①依簡章條件附證明(影本經就讀國中教務處核章)<br>
</div>
<div class="col-sm-10 text-left">
<input type="checkbox" name="st_15" value="2" <?php if ($S['st_15']==2) echo "checked" ?> >②若未獲直接錄取,願意參加科學能力檢定
</div>
<div class="col-sm-10 text-left">
<input type="checkbox" name="st_12" value="1" <?php if ($S['st_12']==1) echo "checked" ?> >科學能力檢定
</div>
<div class="col-sm-10 text-left">
<input type="checkbox" name="st_13" value="1" <?php if ($S['st_13']==1) echo "checked" ?> >曾獲得全國科學展覽前三名,附證明(影本經就讀國中教務處核章)
</div>
</div>
</div>
</div>
<div class="button-group">
<input class="btn btn-primary" type="submit" value="修改資料">
<input class="btn btn-info" type="reset" value="重填">
<input class="btn btn-danger" type="reset" value="不修改回上頁" onClick="javascript:location.href='main.php'">
</div>
</form>
</div>
</div>
</div>
</div>