www.reg-jobu.thurstancollege.com Open in urlscan Pro
67.222.8.49  Public Scan

Form analysis
1 forms found in the DOM

POST

<form method="post">
  <div class="form-row">
    <div class="form-group col-md-12">
      <label for="iname">Name With Initials<sup>*</sup></label>
      <input type="text" class="form-control" name="iname" placeholder="M T Perera" value="" required="">
      <lable class="how">Ex: M T Perera</lable>
    </div>
  </div>
  <div class="form-row">
    <div class="form-group col-md-12">
      <label for="name">Full Name <sup>*</sup></label>
      <input type="text" class="form-control" name="name" placeholder="Manjula Theekshana Perera" value="" required="">
      <lable class="how">Ex: Manjula Theekshana Perera</lable>
    </div>
  </div>
  <div class="form-group">
    <label for="address">Address <sup>*</sup></label>
    <input type="text" class="form-control" name="address" placeholder="1234, Main St, Colombo" value="" required="">
    <lable class="how">Ex: 1234 Main St Colombo</lable>
  </div>
  <div class="form-row">
    <div class="form-group col-md-12 col-lg-6">
      <label for="email">E-mail <sup>*</sup></label>
      <input type="email" class="form-control" name="email" placeholder="manjula@sample.com" value="" required="">
      <lable class="how">Ex: manjula@sample.com</lable>
    </div>
    <div class="form-group col-md-12 col-lg-3">
      <label for="mob1">Phone 1 <sup>*</sup></label>
      <input type="tel" class="form-control" name="mob1" placeholder="0712345678" value="" required="">
      <lable class="how">Ex: 0712345678</lable>
    </div>
    <div class="form-group col-md-12 col-lg-3">
      <label for="mob2">Phone 2</label>
      <input type="tel" class="form-control" name="mob2" placeholder="0712345678" value="">
    </div>
  </div>
  <div class="form-row">
    <div class="form-group col-md-12 col-lg-3">
      <label for="idnumber">NIC Number <sup>*</sup></label>
      <input type="text" class="form-control" name="idnumber" placeholder="199312345678" value="" required="">
      <lable class="how">Ex: 199312345678</lable>
    </div>
    <div class="form-group col-md-12 col-lg-3">
      <label for="dob">Dat of Birth <sup>*</sup></label>
      <input type="date" class="form-control" name="dob" value="" required="">
      <lable class="how">Ex: 2005-01-01</lable>
    </div>
  </div>
  <hr>
  <div class="form-row">
    <div class="form-group col-md-12 col-lg-4">
      <label for="addyear">Admission Year <sup>*</sup></label>
      <input type="number" class="form-control" name="addyear" placeholder="2011" value="" required="">
      <lable class="how">2011</lable>
    </div>
    <div class="form-group col-md-12 col-lg-4">
      <label for="addclass">Admission Class <sup>*</sup></label>
      <input type="text" class="form-control" name="addclass" placeholder="1-Nelum or 8-C" value="" required="">
      <lable class="how">Ex: 1-Nelum or 8-C</lable>
    </div>
    <div class="form-group col-md-12 col-lg-4">
      <label for="addno">Admission Number <sup>*</sup></label>
      <input type="text" class="form-control" name="addno" placeholder="12345" value="" required="">
      <lable class="how">12345</lable>
    </div>
  </div>
  <div class="form-row p-2 pt-3" style="background: #fff0f0;">
    <div class="form-group col-md-12 col-lg-4">
      <label for="official">Official <sup>***</sup></label>
      <input type="password" class="form-control" name="official" value="" required="">
      <lable class="how text-danger">The above section should be filled out by an office bearer of JOBU</lable>
    </div>
    <div class="form-group col-md-12 col-lg-6" "="">
                        <label>If all the information is correct,</label>
                        <button type=" submit" class="btn btn-primary" name="submit" value="submit">Register him as a JOBU member</button>
    </div>
  </div>
</form>

Text Content

Name With Initials* Ex: M T Perera
Full Name * Ex: Manjula Theekshana Perera
Address * Ex: 1234 Main St Colombo
E-mail * Ex: manjula@sample.com
Phone 1 * Ex: 0712345678
Phone 2
NIC Number * Ex: 199312345678
Dat of Birth * Ex: 2005-01-01

--------------------------------------------------------------------------------

Admission Year * 2011
Admission Class * Ex: 1-Nelum or 8-C
Admission Number * 12345
Official *** The above section should be filled out by an office bearer of JOBU
If all the information is correct, Register him as a JOBU member