<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();
});
});
