<form id="form_01" class="o-form">
<div class="grid-container">
<div class="grid-x grid-margin-x">
<div class="cell">
<fieldset class="o-form__field">
<legend>Anrede<span class="required">*</span></legend>
<input type="radio" class="o-form__input o-form__input--radio o-form__input--hidden" name="radioButtons" value="frau" id="radio-anrede-f" required>
<label class="o-form__label o-form__label--radio" for="radio-anrede-f">Frau</label>
<input type="radio" class="o-form__input o-form__input--radio o-form__input--hidden" name="radioButtons" value="mann" id="radio-anrede-m">
<label class="o-form__label o-form__label--radio" for="radio-anrede-m">Herr</label>
</fieldset>
</div>
<div class="cell large-6 medium-6">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="text" class="o-form__input o-form__input--text " placeholder="Bitte ausfüllen" aria-describedby="input-01" required>
<label class="o-form__label">Nachname<span class="required">*</span></label>
</div>
<span class="o-form__status o-form__status--warning">
</span>
<span class="o-form__info" id="input-01"></span>
</div>
</div>
<div class="cell large-6 medium-6">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="text" class="o-form__input o-form__input--text " placeholder="Bitte ausfüllen" aria-describedby="input-01" required>
<label class="o-form__label">Vorname<span class="required">*</span></label>
</div>
<span class="o-form__status o-form__status--warning">
</span>
<span class="o-form__info" id="input-01"></span>
</div>
</div>
<div class="cell large-8 medium-8">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="text" class="o-form__input o-form__input--text " placeholder="Bitte ausfüllen" aria-describedby="input-01" required>
<label class="o-form__label">Straße<span class="required">*</span></label>
</div>
<span class="o-form__status o-form__status--warning">
</span>
<span class="o-form__info" id="input-01"></span>
</div>
</div>
<div class="cell large-4 medium-4">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="number" class="o-form__input o-form__input--number " placeholder="Bitte ausfüllen" aria-describedby="input-04" pattern="number">
<label class="o-form__label">Hausnummer</label>
</div>
<span class="o-form__info" id="input-04"></span>
</div>
</div>
<div class="cell large-4 medium-4">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="number" class="o-form__input o-form__input--number " placeholder="Bitte ausfüllen" aria-describedby="input-04" pattern="number">
<label class="o-form__label">PLZ</label>
</div>
<span class="o-form__info" id="input-04"></span>
</div>
</div>
<div class="cell large-8 medium-8">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="text" class="o-form__input o-form__input--text " placeholder="Bitte ausfüllen" aria-describedby="input-01" required>
<label class="o-form__label">Ort<span class="required">*</span></label>
</div>
<span class="o-form__status o-form__status--warning">
</span>
<span class="o-form__info" id="input-01"></span>
</div>
</div>
<div class="cell">
<div class="o-form__field">
<div class="o-form__fluid">
<input title="" type="text" class="o-form__input o-form__input--text " placeholder="Bitte ausfüllen" aria-describedby="input-01" required>
<label class="o-form__label">E-Mail<span class="required">*</span></label>
</div>
<span class="o-form__status o-form__status--warning">
</span>
<span class="o-form__info" id="input-01"></span>
</div>
</div>
<div class="cell">
<div class="o-form__field">
<div class="o-form__fluid">
<textarea class="o-form__textarea" placeholder="Schreiben Sie uns" rows="10" required></textarea>
<label class="o-form__label">
Ihre Nachricht<span class="required">*</span> </label>
</div>
</div>
</div>
<div class="cell">
<fieldset class="o-form__field">
<legend>Themen auswählen<span class="required">*</span></legend>
<input class="o-form__input o-form__input--checkbox o-form__input--hidden" type="checkbox" value="thema1" id="thema1" required>
<label class="o-form__label o-form__label--checkbox" for="thema1">
Hildesheimer</label>
<input class="o-form__input o-form__input--checkbox o-form__input--hidden" type="checkbox" value="thema2" id="thema2">
<label class="o-form__label o-form__label--checkbox" for="thema2">
Themen des Tages</label>
<input class="o-form__input o-form__input--checkbox o-form__input--hidden" type="checkbox" value="thema3" id="thema3">
<label class="o-form__label o-form__label--checkbox" for="thema3">
Sport</label>
<input class="o-form__input o-form__input--checkbox o-form__input--hidden" type="checkbox" value="thema4" id="thema4">
<label class="o-form__label o-form__label--checkbox" for="thema4">
Regional</label>
</fieldset>
</div>
<div class="cell">
<fieldset class="o-form__field">
<div class="o-form__fluid">
<select id="select_1" required class="o-form__select">
<option value="abo1">Abo EXTRA</option>
<option value="abo2">Abo Basis-Paket</option>
<option value="abo3">Abo Premium-Paket</option>
<option value="abo4">Abo Exklusiv-Paket</option>
</select>
<label class="o-form__label">Abo auswählen<span class="required">*</span></label>
</div>
<p class="o-form__info" id="select_desc_1">*Pflichtfeld</p>
<span class="o-form__status o-form__status--warning">
</span>
</fieldset>
</div>
<div class="cell">
<fieldset class="o-form__field">
<legend>Datenschutz<span class="required">*</span></legend>
<input class="o-form__input o-form__input--checkbox o-form__input--hidden" type="checkbox" value="confirm_privacy" id="from_privacy" required>
<label class="o-form__label o-form__label--checkbox" for="from_privacy">
Mit dem Absenden Ihrer Anfrage erklären Sie sich mit der Verarbeitung Ihrer angegebenen Daten zum Zweck der Bearbeitung Ihrer Anfrage einverstanden (<a href='#'>Datenschutzerklärung</a>).*</label>
</fieldset>
</div>
<div class="cell medium-4 medium-offset-8">
<input type="submit" class="o-form__input c-button c-button--full" value="Absenden">
</div>
</div>
</div>
</form>
<form id="form_01" class="o-form">
<div class="grid-container">
<div class="grid-x grid-margin-x">
<div class="cell"> {% render '@radio' with {
"legend":"Anrede",
"items": [
{
"label": "Frau",
"id": "radio-anrede-f",
"value": "frau"
},{
"label": "Herr",
"id": "radio-anrede-m",
"value": "mann"
}]
} %}</div>
<div class="cell large-6 medium-6">
{% render '@input' with { "label":"Nachname"} %}
</div>
<div class="cell large-6 medium-6">{% render '@input' with { "label":"Vorname" } %}
</div>
<div class="cell large-8 medium-8">
{% render '@input' with { "label":"Straße" } %}
</div>
<div
class="cell large-4 medium-4">
{% render '@input--number' with { "label":"Hausnummer" } %}
</div>
<div class="cell large-4 medium-4">
{% render '@input--number' with { "label":"PLZ" } %}
</div>
<div class="cell large-8 medium-8">
{% render '@input' with { "label":"Ort" } %}
</div>
<div class="cell">
{% render '@input' with { "label":"E-Mail" } %}
</div>
<div class="cell">
{% render '@textarea' with { "label":"Ihre Nachricht" } %}
</div>
<div class="cell">
{% render '@checkbox' with {
"legend":"Themen auswählen",
"items": [
{
"label": "Hildesheimer",
"id": "thema1",
"value": "thema1"
},{
"label": "Themen des Tages",
"id": "thema2",
"value": "thema2"
},{
"label": "Sport",
"id": "thema3",
"value": "thema3"
},{
"label": "Regional",
"id": "thema4",
"value": "thema4"
}
]} %}
</div>
<div class="cell">
{% render '@select' with {
"label":"Abo auswählen",
"items": [
{
"option": "Abo EXTRA",
"value": "abo1"
},{
"option": "Abo Basis-Paket",
"value": "abo2"
},{
"option": "Abo Premium-Paket",
"value": "abo3"
},{
"option": "Abo Exklusiv-Paket",
"value": "abo4"
}
]} %}
</div>
<div class="cell">
{% render '@checkbox' with {
"legend":"Datenschutz",
"items": [
{
"label": "Mit dem Absenden Ihrer Anfrage erklären Sie sich mit der Verarbeitung Ihrer angegebenen Daten zum Zweck der Bearbeitung Ihrer Anfrage einverstanden (<a href='#'>Datenschutzerklärung</a>).*",
"id": "from_privacy",
"value": "confirm_privacy"
}
]} %}
</div>
<div class="cell medium-4 medium-offset-8">
{% render '@submit' with { "label":"Absenden"} %}
</div>
</div>
</div>
</form>
/* No context defined for this component. */
There are no notes for this item.