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register.html 1.4 KiB

11 months ago
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  1. <!DOCTYPE html>
  2. <html lang="en">
  3. <head>
  4. <meta charset="UTF-8">
  5. <meta name="viewport" content="width=device-width, initial-scale=1.0">
  6. <title>Registration</title>
  7. </head>
  8. <body>
  9. <h1>Registration</h1>
  10. <form method="post" action="/register">
  11. <label for="username">Username (Email):</label>
  12. <input type="text" id="username" name="username" required>
  13. <label for="password">Password:</label>
  14. <input type="password" id="password" name="password" required>
  15. <label for="name">Given Name:</label>
  16. <input type="text" id="name" name="name" required>
  17. <label for="surname">Surname:</label>
  18. <input type="text" id="surname" name="surname" required>
  19. <label for="city">City:</label>
  20. <input type="text" id="city" name="city" required>
  21. <label for="phone_number">Phone Number:</label>
  22. <input type="text" id="phone_number" name="phone_number" required>
  23. <label for="profile_description">Profile Description:</label>
  24. <textarea id="profile_description" name="profile_description" rows="4" required></textarea>
  25. <label for="role">Role:</label>
  26. <select id="role" name="role" required>
  27. <option value="family">Family</option>
  28. <option value="caregiver">Caregiver</option>
  29. </select>
  30. <button type="submit">Register</button>
  31. </form>
  32. </body>
  33. </html>