Toggle navigation
Bootsnipp
Bootstrap
For
CSS Frameworks
Bootstrap
Foundation
Semantic UI
Materialize
Pure
Bulma
References
CSS Reference
Tools
Community
Page Builder
Form Builder
Button Builder
Icon Search
Dan's Tools
Diff / Merge
Color Picker
Keyword Tool
Web Fonts
.htaccess Generator
Favicon Generator
Site Speed Test
Snippets
Featured
Tags
By Bootstrap Version
4.1.1
4.0.0
3.3.0
3.2.0
3.1.0
3.0.3
3.0.1
3.0.0
2.3.2
Register
Login
"form_registration"
Bootstrap 3.3.0 Snippet by
rantau
3.3.0
registration
Preview
HTML
View Full Screen
Fork
Fork this
7.9K
 
3 Fav
Post to Facebook
Tweet this
<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"> <h2>Formulir Pendaftaran SMA Kanisius</h2> </div> <form class="form-horizontal"> <fieldset> <!-- Form Name --> <legend>Biodata Calon Siswa</legend> <!-- Nama Calon Siswa--> <div class="form-group"> <label class="col-md-4 control-label" for="nama">Nama Calon Siswa</label> <div class="col-md-6"> <input id="nama" name="nama" placeholder="Nama Lengkap" class="form-control input-md" required="" type="text"> <span class="help-block">Isi dengan nama lengkap sesuai dengan akta kelahiran dan Ijasah</span> </div> </div> <!-- Nama Panggilan --> <div class="form-group"> <label class="col-md-4 control-label" for="panggilan">Nama Panggilan</label> <div class="col-md-6"> <input id="panggilan" name="panggilan" placeholder="Nama Panggilan" class="form-control input-md" type="text"> </div> </div> <!-- Tanggal Lahir--> <div class="form-group"> <label class="col-md-4 control-label" for="tempatlahir">Tempat, Tanggal Lahir</label> <div class="col-md-6"> <input id="tempatlahir" name="tempatlahir" placeholder="Tempat, Tanggal Lahir" class="form-control input-md" required="" type="text"> </div> </div> <!-- Kewarganegaraan dan agama--> <div class="form-group"> <label class="col-md-4 control-label" for="kewarganegaraan">Kewarganegaraan</label> <div class="col-md-2"> <input id="kewarganegaraan" name="kewarganegaraan" placeholder="" class="form-control input-md" type="text"> </div> <label class="col-md-1 control-label" for="kewarganegaraan">Agama</label> <div class="col-md-2"> <select id="Agama" name="Agama" class="form-control"> <option value="0">-- Pilih Agama --</option> <option value="1">Katolik</option> <option value="2">Islam</option> <option value="3">Hindu</option> <option value="4">Buddha</option> <option value="5">Kristen</option> </select> </div> </div> <!-- Text input--> <div class="form-group"> <label class="col-md-4 control-label" for="nisn">NISN</label> <div class="col-md-6"> <input id="nisn" name="nisn" placeholder="Nomor Induk Siswa Nasional" class="form-control input-md" required="" type="text"> </div> </div> <!-- NPSN --> <div class="form-group"> <label class="col-md-4 control-label" for="npsn">NPSN Asal Sekolah</label> <div class="col-md-3"> <input id="npsn" name="npsn" placeholder="" class="form-control input-md" type="text"> </div> <div class="col-md-3"> <input id="sekolah_asal" name="nama_sekolah" placeholder="Nomor NPSN Sekolah Asal" class="form-control input-md" type="text"> </div> </div> <!--------------------------- Biodata Calon Siswa ------------------------------------------------> <div class="form-group"> <label class="col-md-4 control-label" for="alamat">Alamat Calon Siswa</label> <div class="col-md-6"> <input id="alamat1" name="alamat1" placeholder="" class="form-control input-md" type="text"> </div> </div> <div class="form-group"> <label class="col-md-4 control-label" for="prependedtext"></label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RT</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RW</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> </div> <!-- Kelurahan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kelurahan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kecamatan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kecamatan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kabupaten --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kabupaten/Kota <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Provinsi --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-2"> Provinsi <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> <div class="col-md-2"> Kode Pos <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!---------------------- Batas Biodata Calon Siswa ------------------------> <!-- Jarak ke Kanisius--> <div class="form-group"> <label class="col-md-4 control-label" for="jarak">Jarak ke Kanisius</label> <div class="col-md-2"> <div class="input-group"> <input id="jarak" name="jarak" class="form-control" placeholder="00" type="text"> <span class="input-group-addon">Kilometer</span> </div> </div> </div> <!--------------------------- Biodata Ayah ------------------------------------------------> <legend>Biodata AYAH</legend> <div class="form-group"> <label class="col-md-4 control-label" for="alamat">Nama Ayah</label> <div class="col-md-6"> <input id="alamat1" name="alamat1" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Tanggal Lahir Ayah --> <div class="form-group"> <label class="col-md-4 control-label" for="tempatlahir">Tempat, Tanggal Lahir</label> <div class="col-md-6"> <input id="tempatlahir" name="tempatlahir" placeholder="Tempat, Tanggal Lahir" class="form-control input-md" required="" type="text"> </div> </div> <!-- Alamat Ayah --> <div class="form-group"> <label class="col-md-4 control-label" for="alamat">Alamat</label> <div class="col-md-6"> <input id="alamat2" name="alamat2" placeholder="" class="form-control input-md" type="text"> </div> </div> <div class="form-group"> <label class="col-md-4 control-label" for="prependedtext"></label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RT</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RW</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> </div> <!-- Kelurahan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kelurahan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kecamatan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kecamatan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kabupaten --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kabupaten/Kota <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Provinsi --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-2"> Provinsi <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> <div class="col-md-2"> Kode Pos <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!---------------------- Batas Biodata Ibu ------------------------> <legend>Biodata IBU</legend> <div class="form-group"> <label class="col-md-4 control-label" for="alamat">Nama Ayah</label> <div class="col-md-6"> <input id="alamat1" name="alamat1" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Tanggal Lahir Ayah --> <div class="form-group"> <label class="col-md-4 control-label" for="tempatlahir">Tempat, Tanggal Lahir</label> <div class="col-md-6"> <input id="tempatlahir" name="tempatlahir" placeholder="Tempat, Tanggal Lahir" class="form-control input-md" required="" type="text"> </div> </div> <!-- Alamat Ayah --> <div class="form-group"> <label class="col-md-4 control-label" for="alamat">Alamat</label> <div class="col-md-6"> <input id="alamat2" name="alamat2" placeholder="" class="form-control input-md" type="text"> </div> </div> <div class="form-group"> <label class="col-md-4 control-label" for="prependedtext"></label> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RT</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> <div class="col-md-2"> <div class="input-group"> <span class="input-group-addon">RW</span> <input id="prependedtext" name="prependedtext" class="form-control" placeholder="00" type="text"> </div> </div> </div> <!-- Kelurahan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kelurahan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kecamatan --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kecamatan <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Kabupaten --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-6"> Kabupaten/Kota <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!-- Provinsi --> <div class="form-group"> <label class="col-md-4 control-label" for=""></label> <div class="col-md-2"> Provinsi <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> <div class="col-md-2"> Kode Pos <input id="" name="" placeholder="" class="form-control input-md" type="text"> </div> </div> <!---------------------- Batas Biodata IBU ------------------------> <!-- Button Submit --> <div class="form-group"> <label class="col-md-4 control-label" for="submit"></label> <div class="col-md-2"> <button id="submit" name="submit" class="btn btn-primary">Simpan</button> </div> </div> </fieldset> </form> </div>
Related:
See More
Template
Paper Dashboard Pro Angular
Questions / Comments:
Post
Posting Guidelines
Formatting
- Now
×
Close
Donate
BTC: 12JxYMYi6Vt3mx3hcmP3B2oyFiCSF3FhYT
ETH: 0xCD715b2E3549c54A40e6ecAaFeB82138148a6c76