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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>Register - CareConnect Haven</title>
<link rel="icon" type="image/x-icon" href="/static/favicon.ico">
<script src="https://cdn.tailwindcss.com"></script>
<script src="https://cdn.jsdelivr.net/npm/feather-icons/dist/feather.min.js"></script>
<script src="https://unpkg.com/feather-icons"></script>
<script>
tailwind.config = {
theme: {
extend: {
colors: {
primary: {
50: '#f0f9ff',
100: '#e0f2fe',
200: '#bae6fd',
300: '#7dd3fc',
400: '#38bdf8',
500: '#0ea5e9',
600: '#0284c7',
700: '#0369a1',
800: '#075985',
900: '#0c4a6e',
},
secondary: {
50: '#fdf4ff',
100: '#fae8ff',
200: '#f5d0fe',
300: '#f0abfc',
400: '#e879f9',
500: '#d946ef',
600: '#c026d3',
700: '#a21caf',
800: '#86198f',
900: '#701a75',
}
}
}
}
}
</script>
<style>
@import url('https://fonts.googleapis.com/css2?family=Inter:wght@300;400;500;600;700&display=swap');
body {
font-family: 'Inter', sans-serif;
}
.form-gradient {
background: linear-gradient(135deg, rgba(14, 165, 233, 0.05) 0%, rgba(217, 70, 239, 0.05) 100%);
}
</style>
</head>
<body class="form-gradient min-h-screen flex items-center justify-center p-4">
<div class="max-w-md w-full space-y-8">
<div class="text-center">
<a href="index.html" class="inline-flex items-center text-2xl font-bold text-gray-900">
<i data-feather="heart" class="h-8 w-8 text-primary-600 mr-2"></i>
CareConnect Haven
</a>
<h2 class="mt-6 text-3xl font-bold text-gray-900">Create Your Account</h2>
<p class="mt-2 text-gray-600">Join our community and get the care you deserve</p>
</div>
<form class="mt-8 space-y-6 bg-white p-8 rounded-2xl shadow-lg">
<div class="space-y-4">
<div class="grid grid-cols-2 gap-4">
<div>
<label for="firstName" class="block text-sm font-medium text-gray-700">First Name</label>
<input type="text" id="firstName" name="firstName" required
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
</div>
<div>
<label for="lastName" class="block text-sm font-medium text-gray-700">Last Name</label>
<input type="text" id="lastName" name="lastName" required
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
</div>
</div>
<div>
<label for="email" class="block text-sm font-medium text-gray-700">Email Address</label>
<input type="email" id="email" name="email" required
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
</div>
<div>
<label for="phone" class="block text-sm font-medium text-gray-700">Phone Number</label>
<input type="tel" id="phone" name="phone"
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
</div>
<div>
<label for="password" class="block text-sm font-medium text-gray-700">Password</label>
<input type="password" id="password" name="password" required
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
</div>
<div>
<label for="careNeeds" class="block text-sm font-medium text-gray-700">Primary Care Needs</label>
<select id="careNeeds" name="careNeeds"
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent">
<option value="">Select your primary need</option>
<option value="personal">Personal Care Assistance</option>
<option value="companionship">Companionship</option>
<option value="medical">Medical Support</option>
<option value="housekeeping">Housekeeping</option>
<option value="transportation">Transportation</option>
<option value="other">Other</option>
</select>
</div>
<div>
<label for="location" class="block text-sm font-medium text-gray-700">Location</label>
<input type="text" id="location" name="location" required
class="mt-1 block w-full px-3 py-2 border border-gray-300 rounded-lg focus:outline-none focus:ring-2 focus:ring-primary-500 focus:border-transparent" placeholder="City, State">
</div>
</div>
<div class="flex items-center">
<input id="agree-terms" name="agree-terms" type="checkbox"
class="h-4 w-4 text-primary-600 focus:ring-primary-500 border-gray-300 rounded">
<label for="agree-terms" class="ml-2 block text-sm text-gray-700">
I agree to the <a href="#" class="text-primary-600 hover:text-primary-500">Terms of Service</a> and <a href="#" class="text-primary-600 hover:text-primary-500">Privacy Policy</a>
</label>
</div>
<div>
<button type="submit"
class="group relative w-full flex justify-center py-3 px-4 border border-transparent text-sm font-medium rounded-lg text-white bg-primary-600 hover:bg-primary-700 focus:outline-none focus:ring-2 focus:ring-offset-2 focus:ring-primary-500 transition-colors">
Create Account
</button>
</div>
<div class="text-center">
<p class="text-sm text-gray-600">
Already have an account?
<a href="login.html" class="font-medium text-primary-600 hover:text-primary-500">
Sign in here
</a>
</p>
</div>
</form>
</div>
<script>
feather.replace();
// Form submission handling
document.querySelector('form').addEventListener('submit', function(e) {
e.preventDefault();
// In a real implementation, this would send data to a backend
alert('Account creation successful! In a real implementation, this would redirect to the dashboard.');
});
</script>
</body>
</html>
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