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index.html
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index.html
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<!DOCTYPE html>
<html>
<head>
<meta charset="utf-8">
<title></title>
<meta name="author" content="">
<meta name="description" content="">
<meta name="viewport" content="width=device-width, initial-scale=1">
<!-- Latest compiled and minified CSS -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/3.4.1/css/bootstrap.min.css" integrity="sha384-HSMxcRTRxnN+Bdg0JdbxYKrThecOKuH5zCYotlSAcp1+c8xmyTe9GYg1l9a69psu" crossorigin="anonymous">
<!-- Optional theme -->
<link rel="stylesheet" href="https://stackpath.bootstrapcdn.com/bootstrap/3.4.1/css/bootstrap-theme.min.css" integrity="sha384-6pzBo3FDv/PJ8r2KRkGHifhEocL+1X2rVCTTkUfGk7/0pbek5mMa1upzvWbrUbOZ" crossorigin="anonymous"></head>
<body>
<div class="container">
<div class="jumbotron">
<h1 class="display-4">Generateur d'attestation covid-19</h1>
<hr class="my-4">
</div>
<form action="/generate" method="POST" enctype="multipart/form-data" >
<fieldset>
<p class="form-group">
Nom et prenom : <input class="form-control" type="text" name="name">
</p>
<p class="form-group">
Date de naissance : <input class="form-control" type="text" name="birthdate">
</p>
<p class="form-group">
Adresse : <input class="form-control" type="text" name="address">
</p>
<p class="form-group">
Motif :<br>
<label><input type="radio" name="reason" value="work" id="work"> Travail</label><br>
<label><input type="radio" name="reason" value="shopping" id="shopping"> Courses</label><br>
<label><input type="radio" name="reason" value="health" id="health"> Santé</label><br>
<label><input type="radio" name="reason" value="family" id="family"> Famille</label><br>
<label><input type="radio" name="reason" value="sports" id="sports"> Sport</label>
</p>
<p class="form-group">
Fait à : <input class="form-control" type="text" name="city">
</p>
<div class="row">
<div class="col-md-6 col-sm-6">
<p class="form-group">
Signature (optionnel, png seulement) : <input class="form-control" type="file" name="signature" accept="image/png">
</p>
</div>
<div class="col-md-6 col-sm-6">
<p class="form-group">
<label>Utiliser la signature par defaut : <input type="checkbox" name="default_signature"></label><br>
<small>Note: une vraie signature est requise pour que l'attestation soit valide. N'utiliser cette option qu'à des fins de tests</small>
</p>
</div>
</div>
<p class="form-group">
<input type="submit" class="form-control" value="Generer">
</p>
</fieldset>
</form>
</div>
</body>
</html>