<div style="font-size: 11pt; margin: 1em 0;">
	<span class="ui-icon ui-icon-info" style="display: inline-block; vertical-align: middle;"></span>
	Use this form to create a new assessment record for a <?php echo $info['form']->school_year; ?>-<?php echo intval(substr($info['form']->school_year, 2, 2)) + 1; ?> wrestling program.  All fields are required.  The totals will be automatically updated. Click <b>Add</b> when finished to add this record to your reconciliation form.
</div>

<br />

<?php echo Form::open(array('url'    => url('/forms/bia/' . $info['form']->id . '/add-assessment'),
					'method' => 'POST',
					'style'  => 'font-size: 11pt;')); ?>

	<?php echo Form::hidden('redirect', url('/forms/bia/' . $info['form']->id . '/edit')); ?>

	
	<?php /*  Activity Program  */ ?>
	<label for="ap_id" style="font-weight: bold;">Program:</label>

	<select name="ap_id" style="width: 350px;">			
		<?php foreach ($info['aps'] as $option): ?>
			<option value="<?php echo $option->id; ?>"><?php echo $option->name; ?></option>
		<?php endforeach; ?>

	</select>	

	<br /><br />	

	<?php /*  Assessment Type  */ ?>
	<label for="type" style="font-weight: bold;">Location:</label>

	<select name="type" style="width: 215px;">						
		<option value="home">Home Site Assessment</option>			
		<option value="regional">Regional Site Assessment</option>			
	</select>
	
	<br /><br />		

	<?php /*  Number PAssed/Failed  */ ?>
	<h2 style="font-size: 12pt; color: #005fa9; margin-bottom: 0.25em;">Number of Hydration Assessments</h2>
	<div class="columns">
		<div class="third">
			<label for="passed" style="font-weight: bold;"># Passed:</label>			
			<?php echo Form::text('passed', null, array('style'             => 'width: 35px;',
												'maxlength'         => '2',
												'data-numbers-only' => 'integer')); ?>
		</div>

		<div class="third">
			<label for="failed" style="font-weight: bold;"># Failed:</label>			
			<?php echo Form::text('failed', null, array('style'             => 'width: 35px;',
												'maxlength'         => '2',
												'data-numbers-only' => 'integer')); ?>			
		</div>

		<div class="third">
			<label for="assesses" style="font-weight: bold;">Total:</label>			
			<?php echo Form::text('assesses', null, array('style'     => 'width: 35px;',
												  'maxlength' => '2',
												  'readonly'  => 'true')); ?>			
		</div>

		<br class="clear" /><br />

		<div class="third">
			<label for="cost" style="font-weight: bold;">Cost: $</label>	
			<?php echo Form::text('cost', null, array('style'             => 'width: 50px;',
											   'data-numbers-only' => 'float')); ?>
		</div>		

		<div class="half" style="width: 60%;">
			Cost per assessment, up to <b>$<span name="limit">4.50</span></b>.
		</div>

		<br class="clear" /><br />

		<div class="third">
			<label for="mileage" style="font-weight: bold;">Mileage: $</label>	
			<?php echo Form::text('mileage', null, array('style'             => 'width: 75px;',
											     'data-numbers-only' => 'float')); ?>
		</div>		

		<div class="half" style="width: 60%;">
			Not to exceed IRS mileage rate of $0.56 / mile.
		</div>

		<br class="clear" />
		<div class="small gray note">Please make contact with any school that will be paying a mileage fee prior to doing the assessment.  Agree upon a mileage fee beforehand and enter in the total amount of mileage you will be reimbursed in this mileage field.</div>
	</div>	

	<div style="float: right; padding: 0.5em 1em 0.5em 2em; margin-top: 1em; background-color: #d9e1e0;">
		<label for="total" style="font-weight: bold;">Total Charge: $</label>	
		<?php echo Form::text('total', null, array('style'    => 'width: 100px;',
										   'readonly' => 'true')); ?>
	</div>


	
	
	
<?php echo Form::close(); ?>

