
<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;">
        {{ form_errors(form) }}
        </div>

        <div id="ssn">
            {{ form_label(form.ssn) }}

            {{ form_widget(form.ssn, { 'attr': {'size': '11', 'class': 'ssn'} }) }}
        </div>
        <div id="first_name">
            {{ form_label(form.first_name) }}
            {{ form_errors(form.first_name) }}
            {{ form_widget(form.first_name, { 'attr': {'size': '30'} }) }}
        </div>
        <div id="middle_name">
            {{ form_label(form.middle_name) }}
            {{ form_errors(form.middle_name) }}
            {{ form_widget(form.middle_name, { 'attr': {'size': '20'} }) }}
        </div>
        <div id="last_name">
            {{ form_label(form.last_name) }}
            {{ form_errors(form.last_name) }}
            {{ form_widget(form.last_name, { 'attr': {'size': '30'} }) }}
        </div>


        <div id="current_address">
        {% if client.currentaddress is defined %}
            <a href="#" onclick='warnUsersSearch("../search/false?clientinformationform%5Bcurrent_address%5D={{ client.currentaddress }} ")'>Current Address:</a>
        {% else %}
            {{ form_label(form.current_address) }}
        {% endif %}
            {{ form_errors(form.current_address) }}
            {{ form_widget(form.current_address, { 'attr': {'size': '50'} }) }}
        </div>
        <div id="email">
            {{ form_label(form.email) }}
            {{ form_errors(form.email) }}
            {{ form_widget(form.email, { 'attr': {'size': '30'} }) }}
        </div>
        <div id="city">
            {{ form_label(form.city) }}
            {{ form_errors(form.city) }}
            {{ form_widget(form.city, { 'attr': {'size': '30'} }) }}
        </div>
        <div id="state">
            {{ form_label(form.state) }}
            {{ form_errors(form.state) }}
            {{ form_widget(form.state, { 'attr': {'size': '2'} }) }}
        </div>
        <div id="zipcode">
            {{ form_label(form.zipcode) }}
            {{ form_errors(form.zipcode) }}
            {{ form_widget(form.zipcode, { 'attr': {'size': '6', 'class': 'zip'} }) }}
        </div>
        <div id="genderLabel">
            {{ form_label(form.gender) }}
            {{ form_errors(form.gender) }}
        </div>
        <div id="genderWidget">
            {{ form_widget(form.gender) }}
        </div>
<br/>
        <div id="home_phone">
            {{ form_label(form.home_phone) }}
            {{ form_errors(form.home_phone) }}
            {{ form_widget(form.home_phone, { 'attr': {'size': '15', 'class': 'phone'} }) }}
        </div>
        <div id="cell_phone">
            {{ form_label(form.cell_phone) }}
            {{ form_errors(form.cell_phone) }}
            {{ form_widget(form.cell_phone, { 'attr': {'size': '15', 'class': 'phone'} }) }}
        </div>
        <div id="work_phone">
            {{ form_label(form.work_phone) }}
            {{ form_errors(form.work_phone) }}
            {{ form_widget(form.work_phone, { 'attr': {'size': '15', 'class': 'phone'} }) }}
        </div>
        <div id="birth_date">
            {{ form_label(form.birth_date) }}
            {{ form_errors(form.birth_date) }}
            {{ form_widget(form.birth_date, { 'attr': {'size': '11', 'class': 'datepicker'} }) }}
        </div>

        <div id="prev_address1">
            {{ form_label(form.prev_address1) }}
            {{ form_errors(form.prev_address1) }}
            {{ form_widget(form.prev_address1, { 'attr': {'size': '100'} }) }}
        </div>
        <div id="prev_address2">
            {{ form_label(form.prev_address2) }}
            {{ form_errors(form.prev_address2) }}
            {{ form_widget(form.prev_address2, { 'attr': {'size': '100'} }) }}
        </div>
        
		<div id="license_no">
            {{ form_label(form.license_no) }}
            {{ form_errors(form.license_no) }}
            {{ form_widget(form.license_no, { 'attr': {'size': '13'} }) }}
        </div>
		<div id="license_state">
            {{ form_label(form.license_state) }}
            {{ form_errors(form.license_state) }}
            {{ form_widget(form.license_state, { 'attr': {'size': '2'} }) }}
        </div>
        <div id="ethnicity">
            {{ form_label(form.ethnicity) }}
            {{ form_errors(form.ethnicity) }}
            {{ form_widget(form.ethnicity, { 'attr': {'style': 'width: 160px;'} }) }}
        </div>

        <div id="employer">
            {{ form_label(form.employer) }}
            {{ form_errors(form.employer) }}
            {{ form_widget(form.employer, { 'attr': {'size': '27'} }) }}
        </div>
        <div id="employment_type">
            {{ form_errors(form.employment_type) }}
            {{ form_widget(form.employment_type) }}
        </div>
<br/>
        <div id="alias">
            {{ form_label(form.alias) }}
            {{ form_errors(form.alias) }}
            {{ form_widget(form.alias, { 'attr': {'size': '30'} }) }}
        </div>
		<div id="church_affiliation">
            {{ form_label(form.church_affiliation) }}
            {{ form_errors(form.church_affiliation) }}
            {{ form_widget(form.church_affiliation, { 'attr': {'size': '30'} }) }}
        </div>
		

        <div style="float: left;">
		
            <div id="other_adult_oneFirstName">
                {{ form_label(form.other_adult_oneFirstName) }}
                {{ form_errors(form.other_adult_oneFirstName) }}
                {{ form_widget(form.other_adult_oneFirstName, { 'attr': {'size': '30'} }) }}
            </div>
            <div id="other_adult_oneLastName">
                {{ form_label(form.other_adult_oneLastName) }}
                {{ form_errors(form.other_adult_oneLastName) }}
                {{ form_widget(form.other_adult_oneLastName, { 'attr': {'size': '30'} }) }}
            </div>
            <div id="other_adult_oneSsn">
                {{ form_label(form.other_adult_oneSsn) }}
                {{ form_errors(form.other_adult_oneSsn) }}
                {{ form_widget(form.other_adult_oneSsn, { 'attr': {'size': '11', 'class': 'ssn'} }) }}
            </div>
         
        </div>
		
		
		
        <div style="float: left; padding:3px;">
		
        <div id="other_adult_twoFirstName">
            {{ form_label(form.other_adult_twoFirstName) }}
            {{ form_errors(form.other_adult_twoFirstName) }}
            {{ form_widget(form.other_adult_twoFirstName, { 'attr': {'size': '30'} }) }}
        </div>
        <div id="other_adult_twoLastName">
            {{ form_label(form.other_adult_twoLastName) }}
            {{ form_errors(form.other_adult_twoLastName) }}
            {{ form_widget(form.other_adult_twoLastName, { 'attr': {'size': '30'} }) }}
        </div>
        <div id="other_adult_twoSsn">
            {{ form_label(form.other_adult_twoSsn) }}
            {{ form_errors(form.other_adult_twoSsn) }}
            {{ form_widget(form.other_adult_twoSsn, { 'attr': {'size': '11', 'class': 'ssn'} }) }}
        </div>
		
		</div>
		

		<br>&nbsp;<br>
		<br>&nbsp;<br>
		<br>&nbsp;<br>
		
        <div id="children">
            {{ form_label(form.children) }}
            {{ form_errors(form.children) }}
			
<br/>
            {{ form_widget(form.children, { 'attr': {'rows': '4', 'cols': '100', 'title': 'Name(s), Sex, Date of Birth'} }) }}
        </div>
        {{ form_rest(form) }}
<br/>


	
