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| <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> | |