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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="utf-8">
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1">
<meta name="description" content="">
<meta name="author" content="">
<title>SB Admin - Bootstrap Admin Template</title>
<!-- Bootstrap Core CSS -->
<link href="css/bootstrap.min.css" rel="stylesheet">
<!-- Custom CSS -->
<link href="css/sb-admin.css" rel="stylesheet">
<!-- Custom Fonts -->
<link href="font-awesome/css/font-awesome.min.css" rel="stylesheet" type="text/css">
<!-- HTML5 Shim and Respond.js IE8 support of HTML5 elements and media queries -->
<!-- WARNING: Respond.js doesn't work if you view the page via file:// -->
<!--[if lt IE 9]>
<script src="https://oss.maxcdn.com/libs/html5shiv/3.7.0/html5shiv.js"></script>
<script src="https://oss.maxcdn.com/libs/respond.js/1.4.2/respond.min.js"></script>
<![endif]-->
</head>
<body>
<div id="wrapper">
<!-- Navigation -->
<nav class="navbar navbar-inverse navbar-fixed-top" role="navigation">
<!-- Brand and toggle get grouped for better mobile display -->
<div class="navbar-header">
<button type="button" class="navbar-toggle" data-toggle="collapse" data-target=".navbar-ex1-collapse">
<span class="sr-only">Toggle navigation</span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
<span class="icon-bar"></span>
</button>
<a class="navbar-brand" href="index.html">SB Admin</a>
</div>
<!-- Top Menu Items -->
<ul class="nav navbar-right top-nav">
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown"><i class="fa fa-envelope"></i> <b class="caret"></b></a>
<ul class="dropdown-menu message-dropdown">
<li class="message-preview">
<a href="#">
<div class="media">
<span class="pull-left">
<img class="media-object" src="http://placehold.it/50x50" alt="">
</span>
<div class="media-body">
<h5 class="media-heading"><strong>John Smith</strong>
</h5>
<p class="small text-muted"><i class="fa fa-clock-o"></i> Yesterday at 4:32 PM</p>
<p>Lorem ipsum dolor sit amet, consectetur...</p>
</div>
</div>
</a>
</li>
<li class="message-preview">
<a href="#">
<div class="media">
<span class="pull-left">
<img class="media-object" src="http://placehold.it/50x50" alt="">
</span>
<div class="media-body">
<h5 class="media-heading"><strong>John Smith</strong>
</h5>
<p class="small text-muted"><i class="fa fa-clock-o"></i> Yesterday at 4:32 PM</p>
<p>Lorem ipsum dolor sit amet, consectetur...</p>
</div>
</div>
</a>
</li>
<li class="message-preview">
<a href="#">
<div class="media">
<span class="pull-left">
<img class="media-object" src="http://placehold.it/50x50" alt="">
</span>
<div class="media-body">
<h5 class="media-heading"><strong>John Smith</strong>
</h5>
<p class="small text-muted"><i class="fa fa-clock-o"></i> Yesterday at 4:32 PM</p>
<p>Lorem ipsum dolor sit amet, consectetur...</p>
</div>
</div>
</a>
</li>
<li class="message-footer">
<a href="#">Read All New Messages</a>
</li>
</ul>
</li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown"><i class="fa fa-bell"></i> <b class="caret"></b></a>
<ul class="dropdown-menu alert-dropdown">
<li>
<a href="#">Alert Name <span class="label label-default">Alert Badge</span></a>
</li>
<li>
<a href="#">Alert Name <span class="label label-primary">Alert Badge</span></a>
</li>
<li>
<a href="#">Alert Name <span class="label label-success">Alert Badge</span></a>
</li>
<li>
<a href="#">Alert Name <span class="label label-info">Alert Badge</span></a>
</li>
<li>
<a href="#">Alert Name <span class="label label-warning">Alert Badge</span></a>
</li>
<li>
<a href="#">Alert Name <span class="label label-danger">Alert Badge</span></a>
</li>
<li class="divider"></li>
<li>
<a href="#">View All</a>
</li>
</ul>
</li>
<li class="dropdown">
<a href="#" class="dropdown-toggle" data-toggle="dropdown"><i class="fa fa-user"></i> John Smith <b class="caret"></b></a>
<ul class="dropdown-menu">
<li>
<a href="#"><i class="fa fa-fw fa-user"></i> Profile</a>
</li>
<li>
<a href="#"><i class="fa fa-fw fa-envelope"></i> Inbox</a>
</li>
<li>
<a href="#"><i class="fa fa-fw fa-gear"></i> Settings</a>
</li>
<li class="divider"></li>
<li>
<a href="#"><i class="fa fa-fw fa-power-off"></i> Log Out</a>
</li>
</ul>
</li>
</ul>
<!-- Sidebar Menu Items - These collapse to the responsive navigation menu on small screens -->
<div class="collapse navbar-collapse navbar-ex1-collapse">
<ul class="nav navbar-nav side-nav">
<li>
<a href="index.html"><i class="fa fa-fw fa-dashboard"></i> Dashboard</a>
</li>
<li>
<a href="tables.html"><i class="fa fa-fw fa-table"></i> Data tables</a>
</li>
<li class="active">
<a href="forms.html"><i class="fa fa-fw fa-edit"></i> Submit a report!</a>
</li>
<li>
<a href="bootstrap-elements.html"><i class="fa fa-fw fa-desktop"></i> About our project</a>
</li>
<li>
<a href="bootstrap-grid.html"><i class="fa fa-fw fa-wrench"></i> Connect with the community</a>
</li>
<li>
<a href="blank-page.html"><i class="fa fa-fw fa-file"></i> Learn about water testing and lead</a>
</li>
<li>
<a href="index-rtl.html"><i class="fa fa-fw fa-dashboard"></i> Community dashboard</a>
</li>
</ul>
</div>
<!-- /.navbar-collapse -->
</nav>
<div id="page-wrapper">
<div class="container-fluid">
<!-- Page Heading -->
<div class="row">
<div class="col-lg-12">
<h1 class="page-header">
Thank you for participating in the WaterWatcher project
</h1>
<h3 class="page-header">
<i>Contribute to your community by letting us know what's wrong
</h3>
<ol class="breadcrumb">
<li>
<i class="fa fa-dashboard"></i> <a href="index.html">Dashboard</a>
</li>
<li class="active">
<i class="fa fa-edit"></i> Forms
</li>
</ol>
</div>
</div>
<!-- /.row -->
<div class="row">
<div class="col-lg-6">
<form role="form">
<div class="form-group">
<label>What are you reporting today?</label>
<div class="radio">
<label>
<input type="radio" name="optionsRadios" id="optionsRadios1" value="option1" checked>I would like to report problems with my water
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="optionsRadios" id="optionsRadios2" value="option2">I am verifying that my water is safe to drink
</label>
</div>
</div>
</div>
<div class="form-group">
<label>Have you tested your water?</label>
<div class="radio">
<label>
<input type="radio" name="optionsRadios" id="optionsRadios1" value="option1" checked>I have tested my water with a verified lead test
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="optionsRadios" id="optionsRadios2" value="option2">I have ran other tests on my water that do not test for lead
</label>
</div>
<div class="radio">
<label>
<input type="radio" name="optionsRadios" id="optionsRadios2" value="option2">I have not ran any tests on my water
</label>
</div>
</div>
</div>
<div class="form-group">
<label>First name:</label>
<input class="form-control" placeholder="Enter text">
</div>
<div class="form-group">
<label>Last name:</label>
<input class="form-control" placeholder="Enter text">
</div>
<div class="form-group">
<label>Email:</label>
<input class="form-control" placeholder="Enter text">
<small class="text-muted">Your email is private and will not be shared. You will only receive important
notifications in the case of an emergency. Your email will be used as your login username in the future.</small>
</div>
<div class="form-group">
<label>Location of report:</label>
<input class="form-control" placeholder="Enter text">
<small class="text-muted">Your address is private and will not be shared. Sharing your location helps
us track our data and locate problem areas in the community</small>
</div>
<div class="form-group">
<label>Upload a picture of the water to help us identify water quality by color</label>
<input type="file">
</div>
<div class="form-group">
<label>Describe all relevant information. Include any details regarding smell and taste</label>
<textarea class="form-control" rows="3"></textarea>
</div>
<div class="form-group">
<label>I would like to receive updates from the Department of Sanitation for my area</label>
<label class="radio-inline">
<input type="radio" name="optionsRadiosInline" id="optionsRadiosInline1" value="option1" checked>Yes
</label>
<label class="radio-inline">
<input type="radio" name="optionsRadiosInline" id="optionsRadiosInline2" value="option2">No
</label>
</div>
<button type="submit" class="btn btn-default">Submit Button</button>
<button type="reset" class="btn btn-default">Reset Button</button>
</form>
</div>
</div>
<!-- /.row -->
</div>
<!-- /.container-fluid -->
</div>
<!-- /#page-wrapper -->
</div>
<!-- /#wrapper -->
<!-- jQuery -->
<script src="js/jquery.js"></script>
<!-- Bootstrap Core JavaScript -->
<script src="js/bootstrap.min.js"></script>
</body>
</html>