<!DOCTYPE html>
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<!--[if gt IE 8]><!--> <html class="no-js"> <!--<![endif]-->
<head>
<title>Student Registration</title>
<?php include("common/head_links.php");?>
</head>
<body class="theme_skin_kinder">
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<p class="browsehappy">You are using an <strong>outdated</strong> browser. Please <a href="http://browsehappy.com/">upgrade your browser</a> to improve your experience.</p>
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<div id="box_wrapper">
<?php include("common/header.php");?>
<section id="topOfPage" class="topTabsWrap color_section">
<div class="container">
<div class="row">
<div class="col-sm-12">
<h3 class="pageTitle h3">Student Registration</h3>
</div>
</div>
</div>
</section>
<section class="mainWrap">
<div class="container">
<div class="row">
<div class="col-sm-12">
<h3 class="title">Registration Now</h3>
<div class="sc_contact_form sc_contact_form_contact" style="border:1px solid #00F; padding:25px;">
<form data-formtype="contact" method="post" action="">
<div class="columnsWrap">
<div class="col-md-4">
<label class="required" for="">First Name</label>
<input id="" type="text" name="f_name">
</div>
<div class="col-md-4">
<label class="required" for="">Last Name</label>
<input id="" type="text" name="l_name">
</div>
<div class="col-md-4">
<label class="required" for="">Father's Name</label>
<input id="" type="text" name="father_name">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-4">
<label class="required" for="">Mother's Name</label>
<input id="" type="text" name="mother_name">
</div>
<div class="col-md-4">
<label class="required" for="">Date of Birth</label>
<input id="" type="text" name="dob">
</div>
<div class="col-md-4">
<label class="required" for="">Gender</label>
<select class="form-control" id="">
<option>Male</option>
<option>Female</option>
</select>
</div>
</div>
<div class="columnsWrap">
<div class="col-md-4">
<label class="required" for="">Mobile No.</label>
<input id="" type="text" name="mobile">
</div>
<div class="col-md-4">
<label class="required" for="">E-mail ID</label>
<input id="" type="text" name="email">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-6">
<label class="required" for="">Present Address</label>
<input id="" type="text" name="p_address">
</div>
<div class="col-md-6">
<label class="required" for="">Communication Address</label>
<input id="" type="text" name="c_address">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-4">
<label class="required" for="">City</label>
<input id="" type="text" name="city">
</div>
<div class="col-md-4">
<label class="required" for="">State</label>
<input id="" type="text" name="state">
</div>
<div class="col-md-4">
<label class="required" for="">Postal Code</label>
<input id="" type="text" name="postal_code">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-4">
<label class="required" for="">Course Selected</label>
<select class="form-control" id="">
<option>Course 1</option>
<option>Course 2</option>
</select>
</div>
<div class="col-md-4">
<label class="required" for="">Course Fees</label>
<select class="form-control" id="">
<option>Rs. 5000</option>
<option>Rs. 10000</option>
</select>
</div>
<div class="col-md-4">
<label class="required" for="">Joining Batch</label>
<select class="form-control" id="">
<option>May</option>
<option>June</option>
</select>
</div>
</div>
<div class="message">
<label class="required" for="">Educational Qualification</label>
<div class="columnsWrap">
<div class="col-md-3">
</div>
<div class="col-md-3">
<strong>Board/University</strong>
</div>
<div class="col-md-3">
<strong>Year of Passing</strong>
</div>
<div class="col-md-3">
<strong>Percentage of Marks</strong>
</div>
</div>
<div class="columnsWrap">
<div class="col-md-3">
<label class="required" for="">Matriculation</label>
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-3">
<label class="required" for="">Higher Secondary</label>
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-3">
<label class="required" for="">Graduation</label>
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
</div>
<div class="columnsWrap">
<div class="col-md-3">
<label class="required" for="">Other Qualification</label>
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
<div class="col-md-3">
<input id="" type="text" name="postal_code">
</div>
</div>
</div>
<div class="sc_contact_form_button">
<div class="squareButton ico">
<a href="#" class="sc_contact_form_submit icon-comment">Register</a>
</div>
</div>
<div class="result sc_infobox"></div>
</form>
</div>
<!-- <form>
<div class="form-group">
<input type="text" class="form-control" id="name" placeholder="Your Name">
</div>
<div class="form-group">
<label for="mobile">Mobile Number:</label>
<input type="text" class="form-control" id="mobile">
</div>
<div class="form-group">
<label for="email">Email ID:</label>
<input type="email" class="form-control" id="email">
</div>
<div class="form-group">
<label for="pwd">Password:</label>
<input type="password" class="form-control" id="pwd">
</div>
<div class="form-group">
<label for="pwd">Retype Password:</label>
<input type="password" class="form-control" id="pwd">
</div>
<div>
<span><img src="captcha.php" alt="Captcha" /> </span><br /><br />
</div>
<div class="form-group">
<label for="mobile">Enter Captcha Code</label>
<input type="text" class="form-control" id="mobile">
</div>
<div class="checkbox">
<label><input type="checkbox"> </i>I accept all <a class="terms" href="#">terms and conditions</a></label>
</div>
<button type="submit" class="btn btn-success pull-right">Create an Account</button>
</form>-->
</div>
</div>
</div>
</section>
<?php include("common/footer.php");?>
</div><!-- eof #box_wrapper -->
<div class="preloader">
<div class="preloader_image"></div>
</div>
<?php include("common/footer_links.php");?>
</body>
</html>