sunrise-cms/public/html/contract-addInterment.html

<div class="modal" role="dialog">
  <div class="modal-background"></div>
  <div class="modal-card">
    <header class="modal-card-head">
      <h3 class="modal-card-title">
        Add Interment
      </h3>
      <button
        class="delete is-close-modal-button"
        aria-label="close"
        type="button"
      ></button>
    </header>
    <section class="modal-card-body">
      <form id="form--contractIntermentAdd">
        <input
          id="contractIntermentAdd--contractId"
          name="contractId"
          type="hidden"
          value=""
        />
        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--deceasedName"
                >Name</label
              >
              <div class="control has-icons-right">
                <input
                  class="input"
                  id="contractIntermentAdd--deceasedName"
                  name="deceasedName"
                  type="text"
                  maxlength="200"
                  autocomplete="off"
                  required
                />
                <span class="icon is-right">
                  <i class="fas fa-asterisk" aria-hidden="true"></i>
                </span>
              </div>
            </div>
          </div>
        </div>
        <div class="field">
          <label class="label" for="contractIntermentAdd--deceasedAddress1"
            >Address</label
          >
          <div class="control">
            <input
              class="input"
              id="contractIntermentAdd--deceasedAddress1"
              name="deceasedAddress1"
              type="text"
              maxlength="50"
              placeholder="Line 1"
              autocomplete="off"
            />
          </div>
        </div>
        <div class="field">
          <div class="control">
            <input
              class="input"
              id="contractIntermentAdd--deceasedAddress2"
              name="deceasedAddress2"
              type="text"
              maxlength="50"
              placeholder="Line 2"
              aria-label="Address Line 2"
              autocomplete="off"
            />
          </div>
        </div>
        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--deceasedCity"
                >City</label
              >
              <div class="control">
                <input
                  class="input"
                  id="contractIntermentAdd--deceasedCity"
                  name="deceasedCity"
                  type="text"
                  maxlength="20"
                  list="datalist--cityDefault"
                />
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label
                class="label"
                for="contractIntermentAdd--deceasedProvince"
                >Province</label
              >
              <div class="control">
                <input
                  class="input"
                  id="contractIntermentAdd--deceasedProvince"
                  name="deceasedProvince"
                  type="text"
                  maxlength="2"
                />
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label
                class="label"
                for="contractIntermentAdd--deceasedPostalCode"
                >Postal Code</label
              >
              <div class="control">
                <input
                  class="input"
                  id="contractIntermentAdd--deceasedPostalCode"
                  name="deceasedPostalCode"
                  type="text"
                  maxlength="7"
                  autocomplete="off"
                />
              </div>
            </div>
          </div>
        </div>
        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--birthDateString">
                Date of Birth
              </label>
              <div class="control has-icons-left">
                <input class="input" id="contractIntermentAdd--birthDateString" name="birthDateString" type="date" />
                <span class="icon is-left">
                  <i class="fas fa-calendar" aria-hidden="true"></i>
                </span>
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--birthPlace">
                Place of Birth
              </label>
              <div class="control">
                <input class="input" id="contractIntermentAdd--birthPlace" name="birthPlace" type="text" maxlength="100" autocomplete="off" list="datalist--cityDefault" />
              </div>
            </div>
          </div>
        </div>
        <div class="columns">
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--deathDateString">
                Date of Death
              </label>
              <div class="control has-icons-left">
                <input class="input" id="contractIntermentAdd--deathDateString" name="deathDateString" type="date" />
                <span class="icon is-left">
                  <i class="fas fa-calendar" aria-hidden="true"></i>
                </span>
              </div>
            </div>
          </div>
          <div class="column">
            <div class="field">
              <label class="label" for="contractIntermentAdd--deathPlace">
                Place of Death
              </label>
              <div class="control">
                <input class="input" id="contractIntermentAdd--deathPlace" name="deathPlace" type="text" maxlength="100" autocomplete="off" list="datalist--cityDefault" />
              </div>
            </div>
          </div>
        </div>
        <label class="label" for="contractIntermentAdd--deathAge">Death Age</label>
        <div class="field has-addons">
          <div class="control">
            <button class="button" type="button" id="button--calculateDeathAge" aria-label="Calculate Age" disabled>
              <span class="icon is-small"><i class="fas fa-calculator" aria-hidden="true"></i></span>
            </button>
          </div>
          <div class="control is-expanded">
            <input class="input has-text-right" id="contractIntermentAdd--deathAge" name="deathAge" type="number" min="0" max="150" />
          </div>
          <div class="control is-expanded">
            <div class="select is-fullwidth">
              <select id="contractIntermentAdd--deathAgePeriod" name="deathAgePeriod" aria-label="Death Age Period">
              </select>
            </div>
          </div>
        </div>
        <div class="field">
          <label class="label" for="contractIntermentAdd--intermentContainerTypeId">Container</label>
          <div class="control">
            <div class="select is-fullwidth">
              <select id="contractIntermentAdd--intermentContainerTypeId" name="intermentContainerTypeId">
                <option value="">(No Container)</option>
                <optgroup label="Non-Cremated" data-is-cremation-type="0"></optgroup>
                <optgroup label="Cremated" data-is-cremation-type="1"></optgroup>
              </select>
            </div>
          </div>
        </div>
      </form>
    </section>
    <footer class="modal-card-foot is-justify-content-right">
      <div class="buttons">
        <button
          class="button is-success"
          type="submit"
          form="form--contractIntermentAdd"
        >
          <span class="icon"><i class="fas fa-plus" aria-hidden="true"></i></span>
          <span>Add Interment</span>
        </button>
        <button class="button is-close-modal-button" type="button">Cancel</button>
      </div>
    </footer>
  </div>
</div>