<?php

/* DorcasTabithaBundle:ClientInformation:clientinformationlayout.html.twig */
class __TwigTemplate_1ce8f15e683028b0831bf892ebc6d3a6 extends Twig_Template
{
    public function __construct(Twig_Environment $env)
    {
        parent::__construct($env);

        $this->parent = false;

        $this->blocks = array(
        );
    }

    protected function doDisplay(array $context, array $blocks = array())
    {
        // line 1
        echo "
<div id=\"navbar\" style=\"font-size:18px;\">   
    <ul>     
        <li><a href=\"javascript: submitFormClient(9)\">Home</a></li>
        <li><a href=\"javascript: submitFormClient(1)\" style=\"background-color:#00b5cb; font-size:30px;\">Client Information</a></li> 
        <li><a href=\"javascript: submitFormClient(2)\">Finance</a></li>
        <li><a href=\"javascript: submitFormClient(3)\">Notes</a></li>
        <li><a href=\"javascript: submitFormClient(4)\">Assistance</a></li>
        <li><a href=\"javascript: submitFormClient(5)\">Referrals</a></li>  
    </ul> 
</div>

        <br>&nbsp;
        <input type=\"button\" value=\"Save/Next\" onclick=\"savenext(false)\" style=\"color:#00b5cb; background-color:white;\" >
        <input type=\"button\" value=\"Cancel Changes\" onClick=\"window.location.reload()\" style=\"color:#00b5cb; background-color:white;\">
        <br>&nbsp;<br>

        <div style=\"color:maroon;\">
        ";
        // line 19
        echo $this->env->getExtension('form')->renderErrors($this->getContext($context, "form"));
        echo "
        </div>

        <div id=\"ssn\">
            ";
        // line 23
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "ssn"));
        echo "

            ";
        // line 25
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "ssn"), array("attr" => array("size" => "11", "class" => "ssn")));
        echo "
        </div>
        <div id=\"first_name\">
            ";
        // line 28
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "first_name"));
        echo "
            ";
        // line 29
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "first_name"));
        echo "
            ";
        // line 30
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "first_name"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div id=\"middle_name\">
            ";
        // line 33
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "middle_name"));
        echo "
            ";
        // line 34
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "middle_name"));
        echo "
            ";
        // line 35
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "middle_name"), array("attr" => array("size" => "20")));
        echo "
        </div>
        <div id=\"last_name\">
            ";
        // line 38
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "last_name"));
        echo "
            ";
        // line 39
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "last_name"));
        echo "
            ";
        // line 40
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "last_name"), array("attr" => array("size" => "30")));
        echo "
        </div>


        <div id=\"current_address\">
        ";
        // line 45
        if ($this->getAttribute($this->getContext($context, "client", true), "currentaddress", array(), "any", true, true)) {
            // line 46
            echo "            <a href=\"#\" onclick='warnUsersSearch(\"../search/false?clientinformationform%5Bcurrent_address%5D=";
            echo twig_escape_filter($this->env, $this->getAttribute($this->getContext($context, "client"), "currentaddress"), "html", null, true);
            echo " \")'>Current Address:</a>
        ";
        } else {
            // line 48
            echo "            ";
            echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "current_address"));
            echo "
        ";
        }
        // line 50
        echo "            ";
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "current_address"));
        echo "
            ";
        // line 51
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "current_address"), array("attr" => array("size" => "50")));
        echo "
        </div>
        <div id=\"email\">
            ";
        // line 54
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "email"));
        echo "
            ";
        // line 55
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "email"));
        echo "
            ";
        // line 56
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "email"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div id=\"city\">
            ";
        // line 59
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "city"));
        echo "
            ";
        // line 60
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "city"));
        echo "
            ";
        // line 61
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "city"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div id=\"state\">
            ";
        // line 64
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "state"));
        echo "
            ";
        // line 65
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "state"));
        echo "
            ";
        // line 66
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "state"), array("attr" => array("size" => "2")));
        echo "
        </div>
        <div id=\"zipcode\">
            ";
        // line 69
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "zipcode"));
        echo "
            ";
        // line 70
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "zipcode"));
        echo "
            ";
        // line 71
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "zipcode"), array("attr" => array("size" => "6", "class" => "zip")));
        echo "
        </div>
        <div id=\"genderLabel\">
            ";
        // line 74
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "gender"));
        echo "
            ";
        // line 75
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "gender"));
        echo "
        </div>
        <div id=\"genderWidget\">
            ";
        // line 78
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "gender"));
        echo "
        </div>
<br/>
        <div id=\"home_phone\">
            ";
        // line 82
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "home_phone"));
        echo "
            ";
        // line 83
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "home_phone"));
        echo "
            ";
        // line 84
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "home_phone"), array("attr" => array("size" => "15", "class" => "phone")));
        echo "
        </div>
        <div id=\"cell_phone\">
            ";
        // line 87
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "cell_phone"));
        echo "
            ";
        // line 88
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "cell_phone"));
        echo "
            ";
        // line 89
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "cell_phone"), array("attr" => array("size" => "15", "class" => "phone")));
        echo "
        </div>
        <div id=\"work_phone\">
            ";
        // line 92
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "work_phone"));
        echo "
            ";
        // line 93
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "work_phone"));
        echo "
            ";
        // line 94
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "work_phone"), array("attr" => array("size" => "15", "class" => "phone")));
        echo "
        </div>
        <div id=\"birth_date\">
            ";
        // line 97
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "birth_date"));
        echo "
            ";
        // line 98
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "birth_date"));
        echo "
            ";
        // line 99
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "birth_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>

        <div id=\"prev_address1\">
            ";
        // line 103
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "prev_address1"));
        echo "
            ";
        // line 104
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "prev_address1"));
        echo "
            ";
        // line 105
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "prev_address1"), array("attr" => array("size" => "100")));
        echo "
        </div>
        <div id=\"prev_address2\">
            ";
        // line 108
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "prev_address2"));
        echo "
            ";
        // line 109
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "prev_address2"));
        echo "
            ";
        // line 110
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "prev_address2"), array("attr" => array("size" => "100")));
        echo "
        </div>
        
\t\t<div id=\"license_no\">
            ";
        // line 114
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "license_no"));
        echo "
            ";
        // line 115
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "license_no"));
        echo "
            ";
        // line 116
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "license_no"), array("attr" => array("size" => "13")));
        echo "
        </div>
\t\t<div id=\"license_state\">
            ";
        // line 119
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "license_state"));
        echo "
            ";
        // line 120
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "license_state"));
        echo "
            ";
        // line 121
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "license_state"), array("attr" => array("size" => "2")));
        echo "
        </div>
        <div id=\"ethnicity\">
            ";
        // line 124
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "ethnicity"));
        echo "
            ";
        // line 125
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "ethnicity"));
        echo "
            ";
        // line 126
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "ethnicity"), array("attr" => array("style" => "width: 160px;")));
        echo "
        </div>

        <div id=\"employer\">
            ";
        // line 130
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "employer"));
        echo "
            ";
        // line 131
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "employer"));
        echo "
            ";
        // line 132
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "employer"), array("attr" => array("size" => "27")));
        echo "
        </div>
        <div id=\"employment_type\">
            ";
        // line 135
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "employment_type"));
        echo "
            ";
        // line 136
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "employment_type"));
        echo "
        </div>
<br/>
        <div id=\"alias\">
            ";
        // line 140
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "alias"));
        echo "
            ";
        // line 141
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "alias"));
        echo "
            ";
        // line 142
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "alias"), array("attr" => array("size" => "30")));
        echo "
        </div>
\t\t<div id=\"church_affiliation\">
            ";
        // line 145
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "church_affiliation"));
        echo "
            ";
        // line 146
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "church_affiliation"));
        echo "
            ";
        // line 147
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "church_affiliation"), array("attr" => array("size" => "30")));
        echo "
        </div>
\t\t

        <div style=\"float: left;\">
\t\t
            <div id=\"other_adult_oneFirstName\">
                ";
        // line 154
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_oneFirstName"));
        echo "
                ";
        // line 155
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_oneFirstName"));
        echo "
                ";
        // line 156
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_oneFirstName"), array("attr" => array("size" => "30")));
        echo "
            </div>
            <div id=\"other_adult_oneLastName\">
                ";
        // line 159
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_oneLastName"));
        echo "
                ";
        // line 160
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_oneLastName"));
        echo "
                ";
        // line 161
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_oneLastName"), array("attr" => array("size" => "30")));
        echo "
            </div>
            <div id=\"other_adult_oneSsn\">
                ";
        // line 164
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_oneSsn"));
        echo "
                ";
        // line 165
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_oneSsn"));
        echo "
                ";
        // line 166
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_oneSsn"), array("attr" => array("size" => "11", "class" => "ssn")));
        echo "
            </div>
         
        </div>
\t\t
\t\t
\t\t
        <div style=\"float: left; padding:3px;\">
\t\t
        <div id=\"other_adult_twoFirstName\">
            ";
        // line 176
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_twoFirstName"));
        echo "
            ";
        // line 177
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_twoFirstName"));
        echo "
            ";
        // line 178
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_twoFirstName"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div id=\"other_adult_twoLastName\">
            ";
        // line 181
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_twoLastName"));
        echo "
            ";
        // line 182
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_twoLastName"));
        echo "
            ";
        // line 183
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_twoLastName"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div id=\"other_adult_twoSsn\">
            ";
        // line 186
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "other_adult_twoSsn"));
        echo "
            ";
        // line 187
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "other_adult_twoSsn"));
        echo "
            ";
        // line 188
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "other_adult_twoSsn"), array("attr" => array("size" => "11", "class" => "ssn")));
        echo "
        </div>
\t\t
\t\t</div>
\t\t

\t\t<br>&nbsp;<br>
\t\t<br>&nbsp;<br>
\t\t<br>&nbsp;<br>
\t\t
        <div id=\"children\">
            ";
        // line 199
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "children"));
        echo "
            ";
        // line 200
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "children"));
        echo "
\t\t\t
<br/>
            ";
        // line 203
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "children"), array("attr" => array("rows" => "4", "cols" => "100", "title" => "Name(s), Sex, Date of Birth")));
        echo "
        </div>
        ";
        // line 205
        echo $this->env->getExtension('form')->renderRest($this->getContext($context, "form"));
        echo "
<br/>


\t
";
    }

    public function getTemplateName()
    {
        return "DorcasTabithaBundle:ClientInformation:clientinformationlayout.html.twig";
    }

    public function isTraitable()
    {
        return false;
    }

    public function getDebugInfo()
    {
        return array (  497 => 205,  492 => 203,  486 => 200,  482 => 199,  468 => 188,  464 => 187,  460 => 186,  454 => 183,  450 => 182,  446 => 181,  440 => 178,  436 => 177,  432 => 176,  419 => 166,  415 => 165,  411 => 164,  405 => 161,  401 => 160,  397 => 159,  391 => 156,  387 => 155,  383 => 154,  373 => 147,  369 => 146,  365 => 145,  359 => 142,  355 => 141,  351 => 140,  344 => 136,  340 => 135,  334 => 132,  330 => 131,  326 => 130,  319 => 126,  315 => 125,  311 => 124,  305 => 121,  301 => 120,  297 => 119,  291 => 116,  287 => 115,  283 => 114,  276 => 110,  272 => 109,  268 => 108,  262 => 105,  258 => 104,  254 => 103,  247 => 99,  243 => 98,  239 => 97,  233 => 94,  229 => 93,  225 => 92,  219 => 89,  215 => 88,  211 => 87,  205 => 84,  201 => 83,  197 => 82,  190 => 78,  184 => 75,  180 => 74,  174 => 71,  170 => 70,  166 => 69,  160 => 66,  156 => 65,  152 => 64,  146 => 61,  142 => 60,  138 => 59,  132 => 56,  128 => 55,  124 => 54,  118 => 51,  113 => 50,  107 => 48,  101 => 46,  99 => 45,  91 => 40,  87 => 39,  83 => 38,  77 => 35,  73 => 34,  69 => 33,  63 => 30,  59 => 29,  55 => 28,  49 => 25,  44 => 23,  37 => 19,  17 => 1,);
    }
}
