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<?php date_default_timezone_set("Asia/Kolkata"); require_once("lib/function.php"); $db = new login_function(); ?> <!DOCTYPE html> <html lang="en"> <head> <meta charset="UTF-8"> <meta name="viewport" content="width=device-width, initial-scale=1.0"> <title>Print Admission Form</title> <link rel="stylesheet" href="D:\style.css"> <style type="text/css"> body { font-family: Cambria; font-size: 19px; } /* text-transform: uppercase; !important; */ width: 400px; font-size: 15px; margin-top: -18px; } /* .text_1{ margin-left:10px; } */ .strikethough { width:70%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; color:#757575; } .strikethough span { background:#fff; padding:0 20px 0px 0px; position: relative; top: 10px; } .strikethough_1{ width:500%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_2{ width:100%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_3{ width:50%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_4{ width:70%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_5{ width:70%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_6{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_7{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_8{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_9{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_10{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_11{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_12{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_13{ width:20%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_14{ width:100%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_18{ width:100%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .strikethough_19{ width:100%; text-align:left; border-bottom: 1px solid #bcbcbc; overflow: inherit; margin:0px 0 30px; font-size: 16px; } .bottom-textbox{ border:none; margin-left:20px; border-bottom:1px solid black; outline:none; } .bottom-border-textbox:focus{ border-bottom-color:blue; } .past_his { } /* .table-container { display: flex; justify-content: center; } table { width: 60%; border-collapse: collapse; } th, td { border: 1px solid #dddddd; text-align: left; padding: 8px; } */ /* th { background-color: #f2f2f2; } .last_tbl th { border: 1px solid #000; text-align: left; padding: 8px; font-size: 16px; } .last_tbl td { border: 1px solid #000; text-align: left; padding: 8px; font-size: 16px; } /* U{ text-decoration-thickness: 2px; } */ input { color: black; font-weight: 700; font-size: 18px; border: none; border-bottom: 1px solid #000; } input:focus { border-bottom: 1px solid #000; } @media print { .backimg { background-image: url('logo/logoo-back - Copy.png'); background-size: 100% 100%; background-repeat: no-repeat; -webkit-print-color-adjust: exact; print-color-adjust: exact; } } </style> </head> <body> <div style="width:1000px; margin:auto; padding: 15px; "> <div style="text-align: center; "> <div style="float:right; font-size:14px; position: relative; width: 250px; text-align: center;margin-top: 20px; "> रजि. नं. महा / ५९३/२०२० ता. २१/१२/२०२० <br /> नोंदणी क्र. एफ. ३०८३४ (सोलापूर) </div> <center> <div style="position: relative; width: 500px;"> <div class="" style="position: relative; right:85%; top:60px;"> <img src="logo\disha.jpg" alt="" height="180px" width="170px" style="border-radius: 150px;" > </div> <h1 style="margin: 0px; margin-top: -170px; font-weight: 1100; font-size: 60px; font-family: Yatra One, system-ui;">दिशा फाऊंडेशन</h1> <h2 style="margin: 0px;"><b>व्यसनमुक्ती व पुनर्वसन केंद्र</b></h2> </div> </center> --------------------------------------------------------------------------------------------------------------<br /> <div style="font-size: 18px; font-weight: 600;"> दारु व आम्लीय पदार्थ * शारीरीक व मानसिक उत्कृष्ठ अध्यात्मिक मार्गदर्शन<br /></div> --------------------------------------------------------------------------------------------------------------<br /> <div style="font-weight:bold; line-height: 26px;border-bottom: 3px solid black;" > सोलापूर - पुणे हायवे रोड, मु. पो. केगांव, ता. उ. सोलापूर <br /> <span style="font-size:18px;">मो. 8999973160, 9359781303, 9284797403 * सेंटर -7620848123</span> </div></div> <div class="backimg" style=" background-image: url('logo/backimg.jpeg'); background-repeat: no-repeat;background-size: 1900px 1800px;"> <div style="width:1000px; margin:auto; padding: 15px; margin-top: 1000px;"> <div style="display: flex; justify-content: space-between; align-items: flex-start;"> <div style="text-align: left;margin-top:70px"> <!--<p>Date: <input class="date" style="width:10px; " >/<input class="date" style="width:10px; " >/<input class="date" style="width:30px;" value="20"></p>--> <br> <br> <p >Patient's Sign .</p> </div> <div style="text-align: left;"> <p>Date: <input class="date" style="width:10px; " >/<input class="date" style="width:10px; " >/<input class="date" style="width:30px;" value="20"></p> <br> <br> <p>Relatives Sign .</p> </div> </div> </div> </body> </html>
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