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File: bg_ortu.php
<h3 class="dtitle">Data Orang Tua</h3> <div class="form-group"> <label class="col-sm-3 control-label">Nama Ayah Kandung<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="nama_ayah_kandung" value=""> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label">Keadaan <span class="text-danger">*</span></label> <div class="col-sm-2"> <select name="keadaan_ayah" class="form-control" > <option value="" selected="selected">-- Pilih --</option> <option value="Masih Hidup">Masih Hidup</option> <option value="Sudah meninggal">Sudah meninggal</option> </select> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label">Pendidikan<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="pendidikan_ayah" value=""> </div> </div> <div class="form-group"> <label class="col-sm-3 control-label">Agama <span class="text-danger">*</span></label> <div class="col-sm-2"> <select name="agama_ayah" class="form-control"> <option value="" selected="selected">-- Pilih --</option> <option value="Islam">Islam</option> <option value="Kristen">Kristen</option> <option value="Katolik">Katolik</option> <option value="Hindu">Hindu</option> <option value="Buddha">Buddha</option> </select> </div> </div> <div class="form-group"> <label for="nama_ibu_kandung" class="col-sm-3 control-label">Pekerjaan<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="pekerjaan_ayah" value=""> </div> </div> <div class="form-group"> <label for="alamat_orangtua" class="col-sm-3 control-label">Alamat <span class="text-danger">*</span></label> <div class="col-sm-5"> <textarea class="form-control" rows="3" placeholder="" name="alamat_ayah"></textarea> </div> </div> <div class="form-group"> <label for="nama_ibu_kandung" class="col-sm-3 control-label">Nama Ibu Kandung<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="nama_ibu_kandung" > </div> </div> <div class="form-group"> <label for="agama" class="col-sm-3 control-label">Keadaan <span class="text-danger">*</span></label> <div class="col-sm-2"> <select name="keadaan_ibu" class="form-control"> <option value="" selected="selected">-- Pilih --</option> <option value="Masih Hidup">Masih Hidup</option> <option value="Sudah meninggal">Sudah meninggal</option> </select> </div> </div> <div class="form-group"> <label for="nama_ibu_kandung" class="col-sm-3 control-label">Pendidikan<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="pendidikan_ibu" value=""> </div> </div> <div class="form-group"> <label for="agama_ibu" class="col-sm-3 control-label">Agama <span class="text-danger">*</span></label> <div class="col-sm-2"> <select name="agama_ibu" class="form-control"> <option value="" selected="selected">-- Pilih --</option> <option value="Islam">Islam</option> <option value="Kristen">Kristen</option> <option value="Katolik">Katolik</option> <option value="Hindu">Hindu</option> <option value="Buddha">Buddha</option> </select> </div> </div> <div class="form-group"> <label for="nama_ibu_kandung" class="col-sm-3 control-label">Pekerjaan<span class="text-danger">*</span></label> <div class="col-sm-4"> <input type="text" class="form-control" name="pekerjaan_ibu" value=""> </div> </div> <div class="form-group"> <label for="alamat_orangtua" class="col-sm-3 control-label">Alamat<span class="text-danger">*</span></label> <div class="col-sm-5"> <textarea class="form-control" rows="3" name="alamat_ibu"></textarea> </div> </div> </div>