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@@ -19,10 +19,6 @@
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@if (session('message'))
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<div class="alert alert-danger">{{ session('message') }}</div>
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@endif
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- <div class='form-group mb-3'>
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- <label class='control-label'>How is quarantine treating you?</label>
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- <textarea class='form-control' type='text' name='howIsQuarantine'></textarea>
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- </div>
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<div class='form-group mb-3'>
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<label class='control-label'>First Name *</label>
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<input class='form-control' type='text' name='nameFirst' required>
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@@ -31,6 +27,7 @@
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<label class='control-label'>Last Name *</label>
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<input class='form-control' type='text' name='nameLast' value='' required>
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</div>
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+
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<div class='form-group mb-3'>
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<label class='control-label'>Sex</label>
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<select class='form-control' name='sex' value='' >
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@@ -107,14 +104,9 @@
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</div>
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</div>
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<hr class="m-neg-4">
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- <div class='form-group mb-3'>
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- <label class='control-label'>Initiative</label>
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- <select name="initiative" class="form-control">
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- <option value="">-- select --</option>
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- @foreach($intiatives as $initiative)
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- <option value="{{$initiative}}">{{$initiative}}</option>
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- @endforeach
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- </select>
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+ <div class='form-group mb-3'>
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+ <label class='control-label'>How did you hear about us?</label>
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+ <textarea class='form-control' type='text' required="" name='initiative'></textarea>
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</div>
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</form>
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</div>
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