TRAINING REGISTRATION FORM

HTML

body {
font-family: Arial, sans-serif;
background-color: #f7f7f7;
margin: 0;
padding: 20px;
}

h2 {
text-align: center;
color: #2c3e50;
}

form {
max-width: 800px;
margin: auto;
background: #fff;
padding: 20px 30px;
border-radius: 8px;
box-shadow: 0 4px 6px rgba(0,0,0,0.1);
}

fieldset {
border: 1px solid #ccc;
padding: 15px;
margin-bottom: 20px;
border-radius: 5px;
}

legend {
font-weight: bold;
color: #34495e;
}

label {
display: block;
margin-top: 10px;
font-weight: bold;
}

input, select, textarea {
width: 100%;
padding: 8px;
margin-top: 5px;
border-radius: 4px;
border: 1px solid #ccc;
box-sizing: border-box;
}

input[type="checkbox"], input[type="radio"] {
width: auto;
margin-right: 5px;
}

.form-actions {
text-align: center;
margin-top: 20px;
}

button {
background-color: #3498db;
color: #fff;
border: none;
padding: 12px 25px;
border-radius: 5px;
cursor: pointer;
font-size: 16px;
}

button:hover {
background-color: #2980b9;
}

Client Profile Form (Initial Registration)

Personal Information

Full Name

Date of Birth

Gender

Select Gender
Male
Female
Other

National ID / Passport

Phone Number

Address

Emergency Contact

Name

Relationship

Phone Number

Medical Background

Known Conditions

Diabetes
Hypertension
Heart Disease
Asthma
Other

Allergies

Current Medications

Past Surgeries

Disability Status

Yes

No

If Yes, describe

Care Requirements

Type of Care Needed

Select Type
Elderly Care
Post-Surgery Care
Disability Support
Chronic Illness Care

Mobility Status

Select Status
Independent
Assisted
Bedridden

Feeding Type

Select Type
Independent
Assisted
Tube Feeding

Assigned Personnel

Assigned Caregiver

Select Caregiver
Caregiver 1
Caregiver 2

Assigned Nurse

Select Nurse
Nurse 1
Nurse 2

const form = document.getElementById('clientProfileForm');

form.addEventListener('submit', function(e) {
e.preventDefault();
const formData = new FormData(form);
let data = {};
formData.forEach((value, key) => {
if(data[key]) {
// For multi-select fields
if(Array.isArray(data[key])){
data[key].push(value);
} else {
data[key] = [data[key], value];
}
} else {
data[key] = value;
}
});
console.log('Form Submission:', data);
alert('Client profile submitted successfully!');
form.reset();
});