CINXE.COM
<!DOCTYPE html> <html lang="en-US"> <head> <meta charset="UTF-8"/> <meta name="viewport" content="width=device-width, initial-scale=1"> <meta name="csrf-param" content="_csrf"> <meta name="csrf-token" content="DeR6KlIy8tGdjVqNA-X964nd0HSvdq4kZvcfjDamJcdX0k1HO0G6nvbMbdVKlJPG3buXHMRO42grv1fmQPZB9A=="> <title></title> <link href="/assets/289942f8/css/bootstrap.css" rel="stylesheet"> <link href="/assets_b/css/site.css" rel="stylesheet"> <link href="/assets_b/css/custom.css" rel="stylesheet"> <script src="//www.google.com/recaptcha/api.js?hl=en" async defer></script></head> <body> <script>var recaptchaCallback = function(response){jQuery('#query-verifycode').val(response);}; var recaptchaExpiredCallback = function(){jQuery('#query-verifycode').val('');};</script> <div class="wrap"> <nav id="w1" class="navbar-inverse navbar-fixed-top navbar"><div class="container"><div class="navbar-header"><button type="button" class="navbar-toggle" data-toggle="collapse" data-target="#w1-collapse"><span class="sr-only">Toggle navigation</span> <span class="icon-bar"></span> <span class="icon-bar"></span> <span class="icon-bar"></span></button><a class="navbar-brand" href="/">WeCare</a></div><div id="w1-collapse" class="collapse navbar-collapse"></div></div></nav> <div class="container"> <style> .padding_td{ padding-left: 15px; } .panel-body a{ color: #337ab7 !important; } .panel-heading a{ color: #000 !important; } #faqdiv p { margin: 0 0 0px; } @media (max-width:600px){ .padding_td{ padding-left: 0px; } } .wrap > .container { padding: 60px 15px 0px !important; } .form-horizontal .radio, .form-horizontal .checkbox, .form-horizontal .radio-inline, .form-horizontal .checkbox-inline { padding-top: 5px !important; margin-top: 0; margin-bottom: 0; } </style> <div class="box box-primary"> <div class="box-header with-border" style="margin-bottom: 20px;"> <div style="clear:both"></div> <div class="box-body"> <div class="query-form"> <form id="w0" class="form-horizontal" action="/studentquery/prospective" method="post" enctype="multipart/form-data"> <input type="hidden" name="_csrf" value="DeR6KlIy8tGdjVqNA-X964nd0HSvdq4kZvcfjDamJcdX0k1HO0G6nvbMbdVKlJPG3buXHMRO42grv1fmQPZB9A=="><div class="form-group field-student-name required"> <label class="col-sm-2" style="text-align: right;" for="student-name">Name</label> <div class="col-sm-4 col-sm-offset-0"> <input type="text" id="student-name" class="form-control" name="Student[name]" maxlength="50" aria-required="true"> <p class="help-block help-block-error "></p> </div> </div> <div class="form-group field-student-email required"> <label class="col-sm-2" style="text-align: right;" for="student-email">Email</label> <div class="col-sm-4 col-sm-offset-0"> <input type="text" id="student-email" class="form-control" name="Student[email]" maxlength="50" aria-required="true"> <p class="help-block help-block-error "></p> </div> </div> <div class="form-group field-student-mobile required"> <label class="col-sm-2" style="text-align: right;" for="student-mobile">mobile</label> <div class="col-sm-4 col-sm-offset-0"> <input type="text" id="student-mobile" class="form-control" name="Student[mobile]" aria-required="true"> <p class="help-block help-block-error "></p> </div> </div> <div class="form-group field-query-query required"> <label class="col-sm-2" style="text-align: right;" for="query-query">Query</label><div class="col-sm-8"><textarea id="query-query" class="form-control" name="Query[query]" rows="6" aria-required="true"></textarea><p class="help-block help-block-error "></p></div> </div> <div class="form-group field-query-verifycode required"> <div class='col-md-9 col-md-offset-2'><input type="hidden" id="query-verifycode" name="Query[verifyCode]"><div class="g-recaptcha" data-sitekey="6Lcmbg8UAAAAAEPIuCwq1iZP1hHuHWOdqeY9Xf35" data-callback="recaptchaCallback" data-expired-callback="recaptchaExpiredCallback"></div> <p class="help-block help-block-error "></p></div> </div> <div class="form-group" style="margin-left: 17%;"> <button type="submit" id="submitbtn" class="btn btn-primary">Submit Your Query</button> </div> </form> </div> </div> </div> </div> </div> </div> <footer class="footer"> <div class="container"> </div> </footer> <script src="/assets/ca340997/jquery.js"></script> <script src="/assets/6cf9fc08/yii.js"></script> <script src="/assets/6cf9fc08/yii.validation.js"></script> <script src="/assets/6cf9fc08/yii.activeForm.js"></script> <script src="/assets/289942f8/js/bootstrap.js"></script> <script>jQuery(function ($) { jQuery('#w0').yiiActiveForm([{"id":"student-name","name":"name","container":".field-student-name","input":"#student-name","error":".help-block.help-block-error","validate":function (attribute, value, messages, deferred, $form) {yii.validation.required(value, messages, {"message":"Name cannot be blank."});yii.validation.string(value, messages, {"message":"Name must be a string.","max":50,"tooLong":"Name should contain at most 50 characters.","skipOnEmpty":1});}},{"id":"student-email","name":"email","container":".field-student-email","input":"#student-email","error":".help-block.help-block-error","validate":function (attribute, value, messages, deferred, $form) {yii.validation.required(value, messages, {"message":"Email cannot be blank."});yii.validation.string(value, messages, {"message":"Email must be a string.","max":50,"tooLong":"Email should contain at most 50 characters.","skipOnEmpty":1});}},{"id":"student-mobile","name":"mobile","container":".field-student-mobile","input":"#student-mobile","error":".help-block.help-block-error","validate":function (attribute, value, messages, deferred, $form) {yii.validation.required(value, messages, {"message":"Mobile cannot be blank."});yii.validation.number(value, messages, {"pattern":/^[+-]?\d+$/,"message":"Mobile must be an integer.","skipOnEmpty":1});}},{"id":"query-query","name":"query","container":".field-query-query","input":"#query-query","error":".help-block.help-block-error","validate":function (attribute, value, messages, deferred, $form) {yii.validation.regularExpression(value, messages, {"pattern":/[&<>]/,"not":true,"message":"Special characters \u0026\u003C\u003E are not permitted.","skipOnEmpty":1});yii.validation.required(value, messages, {"message":"Query cannot be blank."});yii.validation.string(value, messages, {"message":"Query must be a string.","skipOnEmpty":1});}},{"id":"query-verifycode","name":"verifyCode","container":".field-query-verifycode","input":"#query-verifycode","error":".help-block.help-block-error","validate":function (attribute, value, messages, deferred, $form) {yii.validation.required(value, messages, {"message":"Verify Code cannot be blank."});}}], []); });</script></body> </html> <style> .navbar-toggle{ display: none; } </style>