@extends('layouts.simpleform')

@section('content')
<br/>

<div class="container">
    <div class="row">
        <div class="col-md-8 col-md-offset-2">
            {!! Layout::openCard() !!}

            @include("layouts.header-messages")

            <p class="text-center">Confirme seus dados antes de prosseguir:</p>

            <form class="form-horizontal" role="form" method="POST" action="{{ url('/register') }}">
                {{ csrf_field() }}

                <div class="form-group{{ $errors->has('name') ? ' has-error' : '' }}">
                    <label for="name" class="col-md-3 control-label">Seu nome</label>

                    <div class="col-md-9">
                        <div class="form-line">
                            <input id="name" type="text" class="form-control" name="name" value="{{ $name }}" required autofocus>
                        </div>

                        @if ($errors->has('name'))
                            <span class="help-block">
                            <strong>{{ $errors->first('name') }}</strong>
                        </span>
                        @endif
                    </div>
                </div>

                <div class="form-group{{ $errors->has('email') ? ' has-error' : '' }}">
                    <label for="email" class="col-md-3 control-label">E-mail</label>

                    <div class="col-md-9">
                        <div class="form-line">
                            <input id="email" type="email" class="form-control" name="email" value="{{ $email }}" required>
                        </div>

                        @if ($errors->has('email'))
                            <span class="help-block">
                            <strong>{{ $errors->first('email') }}</strong>
                        </span>
                        @endif
                    </div>
                </div>

                {{Form::hidden('provider',$provider)}}
                {{Form::hidden('provider_id',$providerId)}}

                <div class="form-group">
                    <div class="col-md-3 col-md-offset-3">
                        <button id="btn_registrar" type="submit" class="btn btn-block btn-primary">
                            Continuar
                        </button>
                    </div>
                </div>
            </form>

            {!! Layout::closeCard() !!}
        </div>
    </div>
</div>

@endsection