"Mix & Match Register"
Bootstrap 3.3.0 Snippet by hsandrade

<link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css"> <script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script> <script src="//code.jquery.com/jquery-1.11.1.min.js"></script> <!------ Include the above in your HEAD tag ----------> <div class="container"> <div class="row"> <div class="col-xs-12 col-sm-8 col-md-6 col-sm-offset-2 col-md-offset-3"> <form role="form"> <h2> <small>Ficha de Atendimento Social</small></h2> <hr class="colorgraph"> <div class="form-group"> <input type="text" name="nome" id="nome" class="form-control input-lg" placeholder="Nome Completo" tabindex="3"> </div> <div class="row"> <div class="col-xs-5 col-sm-5 col-md-5"> <div class="form-group"> <input type="text" name="dn" id="dn" class="form-control input-lg" placeholder="Data de Nascimento" tabindex="1"> </div> </div> <div class="col-xs-3 col-sm-3 col-md-3"> <div class="form-group"> <input type="text" name="idade" id="idade" class="form-control input-lg" placeholder="Idade" tabindex="2"> </div> </div> <div class="col-xs-4 col-sm-4 col-md-4"> <div class="form-group"> <select id="estadocivil" name="estadocivil" class="form-control input-lg" tabindex="2"> <option value="">Estado Civil</option> <option value="Casado(a)">Casado(a)</option> <option>Divorciado(a)</option> <option>Solteiro(a)</option> </select> </div> </div> </div> <div class="form-group"> <input type="text" name="endereco" id="endereco" class="form-control input-lg" placeholder="Endereço" tabindex="3"> </div> <div class="form-group"> <input type="email" name="email" id="email" class="form-control input-lg" placeholder="Email" tabindex="4"> </div> <div class="row"> <div class="col-xs-5 col-sm-5 col-md-5"> <div class="form-group"> <select id="curso" name="curso" class="form-control input-lg" tabindex="2"> <option value="">Curso</option> <option value="Aquicultura">Aquicultura</option> <option value="Agroecologia">Agroecologia</option> </select> </div> </div> <div class="col-xs-4 col-sm-4 col-md-4"> <div class="form-group"> <select id="curso" name="curso" class="form-control input-lg" tabindex="2"> <option value="">Modalidade</option> <option value="Integrado">Integrado</option> <option value="Subsequente">Subsequente</option> <option value="Superior">Superior</option> <option value="Parfor">Parfor</option> </select> </div> </div> </div> <div class="row"> <div class="col-xs-5 col-sm-5 col-md-5"> <div class="form-group"> <select id="curso" name="curso" class="form-control input-lg" tabindex="2"> <option value="">Turno</option> <option value="Manhã">Manhã</option></option> <option value="Tarde">Tarde</option> <option value="Noite">Noite</option> </select> </div> </div> <div class="col-xs-4 col-sm-4 col-md-4"> <div class="form-group"> <input type="text" name="bimestre" id="bimestre" class="form-control input-lg" placeholder="Bimestre" tabindex="2"> </div> </div> </div> <div class="row"> <div class="col-xs-6 col-sm-6 col-md-6"> <div class="form-group"> <input type="password" name="password" id="password" class="form-control input-lg" placeholder="Password" tabindex="5"> </div> </div> <div class="col-xs-6 col-sm-6 col-md-6"> <div class="form-group"> <input type="password" name="password_confirmation" id="password_confirmation" class="form-control input-lg" placeholder="Confirm Password" tabindex="6"> </div> </div> </div> <div class="row"> <div class="col-xs-3 col-sm-3 col-md-3"> <span class="button-checkbox"> <button type="button" class="btn" data-color="info" tabindex="7">I Agree</button> <input type="checkbox" name="t_and_c" id="t_and_c" class="hidden" value="1"> </span> </div> <div class="col-xs-9 col-sm-9 col-md-9"> By clicking <strong class="label label-primary">Register</strong>, you agree to the <a href="#" data-toggle="modal" data-target="#t_and_c_m">Terms and Conditions</a> set out by this site, including our Cookie Use. </div> </div> <hr class="colorgraph"> <div class="row"> <div class="col-xs-6 col-md-6"><input type="submit" value="Register" class="btn btn-primary btn-block btn-lg" tabindex="7"></div> <div class="col-xs-6 col-md-6"><a href="#" class="btn btn-success btn-block btn-lg">Sign In</a></div> </div> </form> </div> </div> <!-- Modal --> <div class="modal fade" id="t_and_c_m" tabindex="-1" role="dialog" aria-labelledby="myModalLabel" aria-hidden="true"> <div class="modal-dialog"> <div class="modal-content"> <div class="modal-header"> <button type="button" class="close" data-dismiss="modal" aria-hidden="true">×</button> <h4 class="modal-title" id="myModalLabel">Terms & Conditions</h4> </div> <div class="modal-body"> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> <p>Lorem ipsum dolor sit amet, consectetur adipisicing elit. Similique, itaque, modi, aliquam nostrum at sapiente consequuntur natus odio reiciendis perferendis rem nisi tempore possimus ipsa porro delectus quidem dolorem ad.</p> </div> <div class="modal-footer"> <button type="button" class="btn btn-primary" data-dismiss="modal">I Agree</button> </div> </div><!-- /.modal-content --> </div><!-- /.modal-dialog --> </div><!-- /.modal --> </div>
.colorgraph { height: 5px; border-top: 0; background: #c4e17f; border-radius: 5px; background-image: -webkit-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4); background-image: -moz-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4); background-image: -o-linear-gradient(left, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4); background-image: linear-gradient(to right, #c4e17f, #c4e17f 12.5%, #f7fdca 12.5%, #f7fdca 25%, #fecf71 25%, #fecf71 37.5%, #f0776c 37.5%, #f0776c 50%, #db9dbe 50%, #db9dbe 62.5%, #c49cde 62.5%, #c49cde 75%, #669ae1 75%, #669ae1 87.5%, #62c2e4 87.5%, #62c2e4); }
$(function () { $('.button-checkbox').each(function () { // Settings var $widget = $(this), $button = $widget.find('button'), $checkbox = $widget.find('input:checkbox'), color = $button.data('color'), settings = { on: { icon: 'glyphicon glyphicon-check' }, off: { icon: 'glyphicon glyphicon-unchecked' } }; // Event Handlers $button.on('click', function () { $checkbox.prop('checked', !$checkbox.is(':checked')); $checkbox.triggerHandler('change'); updateDisplay(); }); $checkbox.on('change', function () { updateDisplay(); }); // Actions function updateDisplay() { var isChecked = $checkbox.is(':checked'); // Set the button's state $button.data('state', (isChecked) ? "on" : "off"); // Set the button's icon $button.find('.state-icon') .removeClass() .addClass('state-icon ' + settings[$button.data('state')].icon); // Update the button's color if (isChecked) { $button .removeClass('btn-default') .addClass('btn-' + color + ' active'); } else { $button .removeClass('btn-' + color + ' active') .addClass('btn-default'); } } // Initialization function init() { updateDisplay(); // Inject the icon if applicable if ($button.find('.state-icon').length == 0) { $button.prepend('<i class="state-icon ' + settings[$button.data('state')].icon + '"></i> '); } } init(); }); });

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