<option value="Viudo">Viudo</option>
<option value="Divorciado">Divorciado</option></select><span class="icon-place"></span></div></div></div>
<div class="element-input<?php
frmd_add_class("input5");
?>
" title="Dirección Completa"><label class="title"><span class="required">*</span></label><div class="item-cont"><input class="large" type="text" name="input5" required="required" placeholder="Dirección"/><span class="icon-place"></span></div></div>
<div class="element-input<?php
frmd_add_class("input6");
?>
" title="Teléfono 1 + Cod. Área"><label class="title"></label><div class="item-cont"><input class="large" type="text" name="input6" placeholder="Teléfono 1 + Cód. Área"/><span class="icon-place"></span></div></div>
<div class="element-input<?php
frmd_add_class("input7");
?>
" title="Teléfono 2 + Cód. Área"><label class="title"></label><div class="item-cont"><input class="large" type="text" name="input7" placeholder="Teléfono 2 + Cód. Área"/><span class="icon-place"></span></div></div>
<div class="element-input<?php
frmd_add_class("input8");
?>
" title="Número de Celular ( +569 xxxxxxxx )"><label class="title"><span class="required">*</span></label><div class="item-cont"><input class="large" type="text" name="input8" required="required" placeholder="Celular"/><span class="icon-place"></span></div></div>
<div class="submit"><input type="submit" value="Siguiente"/></div></form><script type="text/javascript" src="<?php
echo dirname($form_path);
?>
/formoid-solid-blue.js"></script>
<!-- Stop Formoid form-->
<?php
}
?>
<?php
frmd_end_form();
define('FINISH_MESSAGE', 'Atividade Registrada com Sucesso!');
define('UPLOAD_ALLOWED_FILE_TYPES', 'doc, docx, xls, csv, txt, rtf, html, zip, jpg, jpeg, png, gif');
define('_DIR_', str_replace('\\', '/', dirname(__FILE__)) . '/');
require_once _DIR_ . '/handler.php';
?>
<?php if (frmd_message()): ?>
<link rel="stylesheet" href="<?php echo dirname($form_path); ?>/formoid-flat-black.css" type="text/css" />
<span class="alert alert-success"><?php echo FINISH_MESSAGE; ?></span>
<?php else: ?>
<!-- Start Formoid form-->
<link rel="stylesheet" href="<?php echo dirname($form_path); ?>/formoid-flat-black.css" type="text/css" />
<script type="text/javascript" src="<?php echo dirname($form_path); ?>/jquery.min.js"></script>
<form class="formoid-flat-black" style="background-color:#FFFFFF;font-size:14px;font-family:'Lato', sans-serif;color:#666666;max-width:800px;min-width:150px" method="post"><div class="title"><h2>Registro de Alterações de Codigo Fonte</h2></div>
<div class="element-multiple<?php frmd_add_class("multiple"); ?>"><label class="title">Responsavel<span class="required">*</span></label><div class="large"><select data-no-selected="Nothing selected" name="multiple[]" multiple="multiple" required="required">
<option value="Miqueias">Miqueias</option>
<option value="Richard">Richard</option>
<option value="Luiz">Luiz</option></select></div></div>
<div class="element-input<?php frmd_add_class("input"); ?>"><label class="title">Caminho do arquivo alterado<span class="required">*</span></label><input class="large" type="text" name="input" required="required"/></div>
<div class="element-date<?php frmd_add_class("date"); ?>"><label class="title">Data<span class="required">*</span></label><input class="large" data-format="yyyy-mm-dd" type="date" name="date" required="required" placeholder="yyyy-mm-dd"/></div>
<div class="element-textarea<?php frmd_add_class("textarea"); ?>"><label class="title">Motivo:</label><textarea class="medium" name="textarea" cols="20" rows="5" ></textarea></div>
<div class="submit"><input type="submit" value="Registrar"/></div></form><script type="text/javascript" src="<?php echo dirname($form_path); ?>/formoid-flat-black.js"></script>
<!-- Stop Formoid form-->
<?php endif; ?>
<?php frmd_end_form(); ?>
