<div class="modal-header">
    <button type="button" class="close" data-dismiss="modal" aria-label="Close">
        <span aria-hidden="true">&times;</span></button>
    <h4 class="modal-title"><?php echo e(trans_choice('general.edit',1)); ?> <?php echo e(trans_choice('general.next_of_kin',1)); ?></h4>
</div>
<form method="post" action="<?php echo e(url('client/next_of_kin/'.$next_of_kin->id.'/update')); ?>"
      class="form-horizontal "
      enctype="multipart/form-data" id="edit_next_of_kin_form">
    <?php echo e(csrf_field()); ?>

    <div class="modal-body">
        <div class="form-group">
            <label for="next_of_kin_first_name"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.first_name',1)); ?></label>
            <div class="col-md-9">
                <input type="text" name="first_name" class="form-control"
                       value="<?php echo e($next_of_kin->first_name); ?>"
                       required id="next_of_kin_first_name">
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_middle_name"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.middle_name',1)); ?></label>
            <div class="col-md-9">
                <input type="text" name="middle_name" class="form-control"
                       value="<?php echo e($next_of_kin->middle_name); ?>"
                       id="next_of_kin_middle_name">
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_last_name"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.last_name',1)); ?></label>
            <div class="col-md-9">
                <input type="text" name="last_name" class="form-control"
                       value="<?php echo e($next_of_kin->last_name); ?>"
                       required id="next_of_kin_last_name">
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_mobile"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.mobile',1)); ?></label>
            <div class="col-md-9">
                <input type="text" name="mobile" class="form-control"
                       value="<?php echo e($next_of_kin->mobile); ?>"
                       id="next_of_kin_mobile">
            </div>
        </div>
        <div class="form-group">
            <label for="client_relationship_id"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.relationship',1)); ?></label>
            <div class="col-md-9">
                <select name="client_relationship_id" class="select2 form-control"
                        id="client_relationship_id" required>
                    <option></option>
                    <?php $__currentLoopData = \App\Models\ClientRelationship::all(); $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $key): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                        <option value="<?php echo e($key->id); ?>"
                                <?php if($next_of_kin->client_relationship_id==$key->id): ?> selected <?php endif; ?>><?php echo e($key->name); ?></option>
                    <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                </select>
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_gender"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.gender',1)); ?></label>
            <div class="col-md-9">
                <select name="gender" class="form-control" id="next_of_kin_gender">
                    <option value="male"  <?php if($next_of_kin->gender=="male"): ?> selected <?php endif; ?>><?php echo e(trans('general.male')); ?></option>
                    <option value="female"  <?php if($next_of_kin->gender=="female"): ?> selected <?php endif; ?>><?php echo e(trans('general.female')); ?></option>
                </select>
            </div>
        </div>

        <div class="form-group">
            <label for="address"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.address',1)); ?></label>
            <div class="col-md-9">
                <input type="text" name="address" class="form-control"
                       value="<?php echo e($next_of_kin->address); ?>"
                       id="address">
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_notes"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.note',2)); ?></label>
            <div class="col-md-9">
                        <textarea name="notes" class="form-control"
                                  id="next_of_kin_notes" rows="3"><?php echo e($next_of_kin->notes); ?></textarea>
            </div>
        </div>
        <div class="form-group">
            <label for="next_of_kin_picture"
                   class="control-label col-md-3"><?php echo e(trans_choice('general.picture',1)); ?></label>
            <div class="col-md-9">
                <input type="file" name="picture" class="form-control"
                       id="next_of_kin_picture">
            </div>
        </div>
    </div>
    <div class="modal-footer">
        <button type="button" class="btn btn-default pull-left"
                data-dismiss="modal"><?php echo e(trans_choice('general.close',1)); ?></button>
        <button type="submit" class="btn btn-primary"><?php echo e(trans_choice('general.save',1)); ?></button>
    </div>
</form><?php /**PATH /home/ic026402/public_html/cres/resources/views/client/edit_next_of_kin.blade.php ENDPATH**/ ?>