page_registro.html.twig
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{% extends 'UBVPrincipalBundle:Documentacion:inicio.html.twig' %}
{% block breadcums %}
{{ parent() }}
<li>
<i class="fa fa-angle-right fa-fw"></i>
<a>Gráficos</a>
</li>
{% endblock%}
{% block configuracion %} <body id="signup-page"> {% endblock%}
{% block layout %}<div id="signup-page-content">{% endblock %}
{% block body %}
<form action="index.html" class="form"><h1 class="block-heading">Regístrate</h1>
<div class="row mbl">
<div class="col-md-6">
<input type="text" name="firstname" value="" placeholder="Nombres" class="form-control">
</div>
<div class="col-md-6">
<input type="text" name="lastname" value="" placeholder="Apellidos" class="form-control">
</div>
</div>
<div class="input-icon mbl">
<i class="fa fa-envelope"></i>
<input type="text" name="email" value="" placeholder="Correo Electronico" class="form-control">
</div>
<div class="input-icon mbl">
<i class="fa fa-key"></i>
<input type="password" name="password" value="" placeholder="Contraseña" class="form-control">
</div>
<div class="mbl">
<input type="password" name="confirm_password" value="" placeholder="Confirmar Contraseña" class="form-control">
</div>
<label>Fecha de Nacimiento</label>
<div class="row mbl">
<div class="col-md-4"><select name="month" class="form-control">
<option value="01">Ene</option>
<option value="02">Feb</option>
<option value="03">Mar</option>
<option value="04">Abr</option>
<option value="05">May</option>
<option value="06">Jun</option>
<option value="07">Jul</option>
<option value="08">Ago</option>
<option value="09">Sep</option>
<option value="10">Oct</option>
<option value="11">Nov</option>
<option value="12">Dic</option>
</select></div>
<div class="col-md-4">
<select name="day" class="form-control">
<option value="1">1</option>
<option value="2">2</option>
<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>
<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>
<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>
<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>
<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select></div>
<div class="col-md-4"><select name="year" class="form-control">
<option value="1935">1935</option>
<option value="1936">1936</option>
<option value="1937">1937</option>
<option value="1938">1938</option>
<option value="1939">1939</option>
<option value="1940">1940</option>
<option value="1941">1941</option>
<option value="1942">1942</option>
<option value="1943">1943</option>
<option value="1944">1944</option>
<option value="1945">1945</option>
<option value="1946">1946</option>
<option value="1947">1947</option>
<option value="1948">1948</option>
<option value="1949">1949</option>
<option value="1950">1950</option>
<option value="1951">1951</option>
<option value="1952">1952</option>
<option value="1953">1953</option>
<option value="1954">1954</option>
<option value="1955">1955</option>
<option value="1956">1956</option>
<option value="1957">1957</option>
<option value="1958">1958</option>
<option value="1959">1959</option>
<option value="1960">1960</option>
<option value="1961">1961</option>
<option value="1962">1962</option>
<option value="1963">1963</option>
<option value="1964">1964</option>
<option value="1965">1965</option>
<option value="1966">1966</option>
<option value="1967">1967</option>
<option value="1968">1968</option>
<option value="1969">1969</option>
<option value="1970">1970</option>
<option value="1971">1971</option>
<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>
<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>
<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>
<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>
<option value="2013">2013</option>
</select></div>
</div>
<label>Genero</label>
<label class="radio-inline"><input id="male" type="radio" name="gender" value="M"> Masculino</label>
<label class="radio-inline"><input id="female" type="radio" name="gender" value="F"> Femenino</label>
<span class="help-block mtm mbl text-muted">
Al hacer clic en Crear mi cuenta , usted está de acuerdo con nuestros Términos y que ha leído nuestra política de uso de datos , incluyendo los cookies
</span>
<button type="submit" class="btn btn-lg btn-primary btn-block">Crear Mi Cuenta</button>
</form>
</div>
{% endblock %}
{% block javascripts %}
{{ parent() }}
{% endblock %}