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DwebCreate Dweb #3107

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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Dweb - School Admission</title>
<style>
body {
font-family: Arial, sans-serif;
margin: 0;
padding: 0;
background-color: #f4f4f4;
}

header {
background-color: #4CAF50;
color: white;
padding: 1rem;
text-align: center;
}

h1 {
margin: 0;
}

form {
width: 50%;
margin: 2rem auto;
background-color: #fff;
padding: 20px;
border-radius: 5px;
box-shadow: 0 0 10px rgba(0, 0, 0, 0.1);
}

label {
font-weight: bold;
display: block;
margin-bottom: 0.5rem;
}

input, select, button {
width: 100%;
padding: 10px;
margin-bottom: 1rem;
border: 1px solid #ccc;
border-radius: 5px;
}

button {
background-color: #4CAF50;
color: white;
border: none;
cursor: pointer;
}

button:hover {
background-color: #45a049;
}

footer {
text-align: center;
padding: 1rem;
background-color: #4CAF50;
color: white;
position: fixed;
bottom: 0;
width: 100%;
}
</style>
</head>
<body>
<header>
<h1>Dweb Application Form</h1>
</header>

<form action="/submit-application" method="post">
<label for="username">Username:</label>
<input type="text" id="username" name="username" placeholder="Enter your username" required>

<label for="email">Email Address:</label>
<input type="email" id="email" name="email" placeholder="Enter your email" required>

<label for="phone">Phone Number:</label>
<input type="tel" id="phone" name="phone" placeholder="Enter your phone number" required>

<label for="location">Location:</label>
<input type="text" id="location" name="location" placeholder="Enter your location" required>

<label for="dob">Date of Birth:</label>
<input type="date" id="dob" name="dob" required>

<label for="gender">Gender:</label>
<select id="gender" name="gender" required>
<option value="" disabled selected>Select your gender</option>
<option value="male">Male</option>
<option value="female">Female</option>
<option value="other">Other</option>
</select>

<button type="submit">Submit Application</button>
</form>

<footer>
<p>&copy; 2023 Dweb Application. All rights reserved.</p>
</footer>
</body>
</html>