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<form action="/" method="post">
  <div class="container">
    <div class="row align-items-center mb-4">
      <div class="col">
        <h1 class="mb-0">Interessentenformular</h1>
      </div>
      <div class="col text-end">
        <a href="/Dienstplan-Bambini-LBN-2024.pdf" target="_blank" class="btn btn-secondary">Dienstplan Nord</a>
        <a href="/Dienstplan-Bambini-BME-2024.pdf" target="_blank" class="btn btn-secondary">Dienstplan West</a>
      </div>
    </div>
    <div class="row">
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-firstname" class="form-label">Vorname</label>
          <input type="text" name="firstname" class="form-control" id="interested-firstname" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-lastname" class="form-label">Nachname</label>
          <input type="text" name="lastname" class="form-control" id="interested-lastname" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-address" class="form-label">Straße, Nr.</label>
          <input type="text" name="address" class="form-control" id="interested-address" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-2">
        <div class="mb-3">
          <label for="interested-zip" class="form-label">PLZ</label>
          <input type="text" name="zip" class="form-control" id="interested-zip" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-4">
        <div class="mb-3">
          <label for="interested-city" class="form-label">Ort</label>
          <input type="text" name="city" class="form-control" id="interested-city" value="Bad Kreuznach" require="">
        </div>
      </div>
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-phone" class="form-label">Telefon</label>
          <input type="tel" name="phone" class="form-control" id="interested-phone" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-email" class="form-label">E-Mail</label>
          <input type="email" name="email" class="form-control" id="interested-email" value="" require="">
        </div>
      </div>
      <div class="col-12 col-sm-3">
        <div class="mb-3">
          <label for="interested-district" class="form-label">Löschbezirk</label>
          <select name="district" class="form-select" id="interested-district" require="">
            <option value="Süd" selected="">Süd</option>
            <option value="Nord">Nord</option>
            <option value="West">West</option>
            <option value="Ost">Ost</option>
          </select>
        </div>
      </div>
      <div class="col-12 col-sm-3">
        <div class="mb-3">
          <label for="interested-department" class="form-label">Abteilung</label>
          <select name="department" class="form-select" id="interested-department" require="">
            <option value="Bambinis" selected="">Bambinis</option>
            <option value="JFW">JFW</option>
            <option value="Aktive">Aktive</option>
          </select>
        </div>
      </div>
      <div class="col-12 col-sm-6">
        <div class="mb-3">
          <label for="interested-comment" class="form-label">Bemerkung</label>
          <textarea name="comment" class="form-control" id="interested-comment" rows="4"></textarea>
        </div>
      </div>
      <div class="col-12">
        <input type="hidden" name="id" value="0">
        <input type="hidden" name="do" value="save">
        <div class="d-flex justify-content-between pt-3">
          <button type="submit" class="btn btn-success">Speichern</button>
          <button type="reset" class="btn btn-danger">Abbrechen</button>
        </div>
      </div>
    </div>
  </div>
</form>

Text Content

INTERESSENTENFORMULAR

Dienstplan Nord Dienstplan West
Vorname
Nachname
Straße, Nr.
PLZ
Ort
Telefon
E-Mail
Löschbezirk Süd Nord West Ost
Abteilung Bambinis JFW Aktive
Bemerkung
Speichern Abbrechen