<?php

/* DorcasTabithaBundle:Assistance:assistanceformaction.html.twig */
class __TwigTemplate_2745019ef4278b601920a2a47251af05 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 "<!--   Copyright JLS Consulting 2012 -->

";
        // line 3
        if ($this->getAttribute($this->getAttribute($this->getContext($context, "app"), "session"), "hasFlash", array(0 => "notice"), "method")) {
            // line 4
            echo "    <div class=\"flash-notice\" style=\"padding-left:27px; position:relative; top:-14px;\">
        &sdot; ";
            // line 5
            echo twig_escape_filter($this->env, $this->getAttribute($this->getAttribute($this->getContext($context, "app"), "session"), "flash", array(0 => "notice"), "method"), "html", null, true);
            echo "
    </div>
";
        }
        // line 8
        echo "
<div id=\"override_javascript_alert\"></div>
<div id=\"override_javascript_alertx\"></div>
<br />
        ";
        // line 12
        if (((($this->getAttribute($this->getContext($context, "history", true), "checksHistory", array(), "any", true, true) && ($this->getAttribute($this->getContext($context, "history"), "checksHistory") != null)) || ($this->getAttribute($this->getContext($context, "history", true), "totalAssist", array(), "any", true, true) && ($this->getAttribute($this->getContext($context, "history"), "totalAssist") != null))) && ($this->getAttribute($this->getContext($context, "history"), "isActive") == 1))) {
            // line 13
            echo "            <div style=\"border:3px solid gray; border-radius: 9px; width:95%; padding:25px;\">

                ";
            // line 15
            if ((($this->getAttribute($this->getContext($context, "history", true), "totalAssist", array(), "any", true, true) && ($this->getAttribute($this->getContext($context, "history"), "isActive") == 1)) && ($this->getAttribute($this->getContext($context, "history"), "totalAssist") != null))) {
                echo "  \t
                    <h4 style=\"line-height:20%;\">\t
                    Assistance History: Total Assistance
                    </h4>
                    <textarea rows=\"2\" cols=\"100\" readonly>";
                // line 19
                echo twig_escape_filter($this->env, $this->getAttribute($this->getContext($context, "history"), "totalAssist"), "html", null, true);
                echo "  </textarea> 
                ";
            }
            // line 21
            echo "
                ";
            // line 22
            if ((($this->getAttribute($this->getContext($context, "history", true), "checksHistory", array(), "any", true, true) && ($this->getAttribute($this->getContext($context, "history"), "isActive") == 1)) && ($this->getAttribute($this->getContext($context, "history"), "checksHistory") != null))) {
                echo "\t
                    <h4>\t
                    Assistance History: Checks Issued / Last Results
                    </h4>
                    <textarea rows=\"3\" cols=\"100\" readonly>";
                // line 26
                echo twig_escape_filter($this->env, $this->getAttribute($this->getContext($context, "history"), "checksHistory"), "html", null, true);
                echo "  </textarea> 
                    <br>&nbsp;<br>
                ";
            }
            // line 29
            echo "

                ";
            // line 31
            $context["uri"] = $this->getAttribute($this->getAttribute($this->getContext($context, "app"), "request"), "uri");
            // line 32
            echo "                ";
            if (($this->env->getExtension('security')->isGranted("ROLE_ADMIN") && (!twig_in_filter("/assistance/", $this->getContext($context, "uri"))))) {
                // line 33
                echo "                    ";
                $context["urlpath"] = $this->env->getExtension('routing')->getPath("DorcasTabithaBundle_assistance_delete_history", array("history_id" => $this->getAttribute($this->getContext($context, "history"), "historyid")));
                // line 34
                echo "                    <input type=\"button\" value=\"Delete History\" onClick=\"location.href='";
                echo twig_escape_filter($this->env, $this->getContext($context, "urlpath"), "html", null, true);
                echo "'\" />            
                ";
            }
            // line 35
            echo " 
                <br/><br />
            </div>  
            <br/><br />
            <br/><br />      
        ";
        }
        // line 41
        echo "

<div style=\"border:3px solid gray; border-radius: 9px; width:97%; padding:15px;\">

<form id=\"clientform\" action=\"";
        // line 45
        echo twig_escape_filter($this->env, $this->env->getExtension('routing')->getPath("DorcasTabithaBundle_assistance_create", array("client_id" => $this->getAttribute($this->getAttribute($this->getContext($context, "assistance"), "client"), "clientid"))), "html", null, true);
        echo "\" method=\"post\" ";
        echo $this->env->getExtension('form')->renderEnctype($this->getContext($context, "form"));
        echo " class=\"dorcas\">

    <h4>Food Given:</h4>

<div id=\"western_wake\">
            ";
        // line 50
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "food_given"));
        echo "
            ";
        // line 51
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "food_given"));
        echo "
            ";
        // line 52
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "food_given"), array("attr" => array("size" => "3", "onchange" => "fgcheckbox(this)")));
        echo " 
        </div>
        <div id=\"western_wake_date\";>
            ";
        // line 55
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "food_given_date"));
        echo "
            ";
        // line 56
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "food_given_date"));
        echo "
            ";
        // line 57
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "food_given_date"), array("attr" => array("size" => "11", "class" => "datepicker", "onchange" => "fgdate(this)")));
        echo "
        </div>


    <br/><br />\t  
\t  
    <h4>Checks Issued:</h4>
    <div style=\" width: 362px; position:relative; top:-40px; left:58%;\">
        Must enter amount in at least one dollar field<hr>
    </div>
    <div style=\"position:relative; top:-40px;\">
        <div style=\"width:17%; float:left;\">
                    Purpose*
                    ";
        // line 70
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "checkpurpose"), array("attr" => array("style" => "width: 160px;")));
        echo "
        </div>
        <div style=\"width:12%; float:left;\">
                    ";
        // line 73
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "checks_issued_date"));
        echo "
                    ";
        // line 74
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "checks_issued_date"));
        echo "
                    ";
        // line 75
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "checks_issued_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 78
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "checks_issued_payee"));
        echo "
                    ";
        // line 79
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "checks_issued_payee"));
        echo "
                    ";
        // line 80
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "checks_issued_payee"), array("attr" => array("size" => "30")));
        echo "
        </div>

        <div style=\"width:11%; float:left;\">
                    ";
        // line 84
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "check_dorcas"));
        echo "
                    ";
        // line 85
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "check_dorcas"));
        echo "
                    ";
        // line 86
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "check_dorcas"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo " 
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 89
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "check_oasis"));
        echo "
                    ";
        // line 90
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "check_oasis"));
        echo "
                    ";
        // line 91
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "check_oasis"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 94
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "check_sfumc"));
        echo "
                    ";
        // line 95
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "check_sfumc"));
        echo "
                    ";
        // line 96
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "check_sfumc"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 99
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "check_other"));
        echo "
                    ";
        // line 100
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "check_other"));
        echo "
                    ";
        // line 101
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "check_other"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo "
        </div>


        <br/><br /><br />
     <h4>Special Programs:</h4>

    <div style=\"width:23%; float:left;\">
                    Program*
                    ";
        // line 110
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "special_program"), array("attr" => array("style" => "width: 220px;")));
        echo "
        </div>
        <div style=\"width:12%; float:left;\">
                    ";
        // line 113
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "special_program_date"));
        echo "
                    ";
        // line 114
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "special_program_date"));
        echo "
                    ";
        // line 115
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "special_program_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 118
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "special_program_recipient_name"));
        echo "
                    ";
        // line 119
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "special_program_recipient_name"));
        echo "
                    ";
        // line 120
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "special_program_recipient_name"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 123
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "special_program_parent_name"));
        echo "
                    ";
        // line 124
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "special_program_parent_name"));
        echo "
                    ";
        // line 125
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "special_program_parent_name"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 128
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($this->getContext($context, "form"), "special_program_check"));
        echo "
                    ";
        // line 129
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($this->getContext($context, "form"), "special_program_check"));
        echo "
                    ";
        // line 130
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($this->getContext($context, "form"), "special_program_check"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo " 
        </div>



            <br /><br /><br />
            <div style=\" padding-top: 18px;\">
                <input type=\"button\" value=\"Save All Above\" onclick=\"saveallabove(false)\" >
            </div> 
    </div> 
\t\t
                ";
        // line 141
        echo $this->env->getExtension('form')->renderRest($this->getContext($context, "form"));
        echo "



   
</form>

</div>

<br /><br /><br />";
    }

    public function getTemplateName()
    {
        return "DorcasTabithaBundle:Assistance:assistanceformaction.html.twig";
    }

    public function isTraitable()
    {
        return false;
    }

    public function getDebugInfo()
    {
        return array (  319 => 141,  305 => 130,  301 => 129,  297 => 128,  291 => 125,  287 => 124,  283 => 123,  277 => 120,  273 => 119,  269 => 118,  263 => 115,  259 => 114,  255 => 113,  249 => 110,  237 => 101,  233 => 100,  229 => 99,  223 => 96,  219 => 95,  215 => 94,  209 => 91,  205 => 90,  201 => 89,  195 => 86,  191 => 85,  187 => 84,  180 => 80,  176 => 79,  172 => 78,  166 => 75,  162 => 74,  158 => 73,  152 => 70,  136 => 57,  132 => 56,  128 => 55,  122 => 52,  118 => 51,  114 => 50,  104 => 45,  98 => 41,  90 => 35,  84 => 34,  81 => 33,  78 => 32,  76 => 31,  72 => 29,  66 => 26,  59 => 22,  56 => 21,  51 => 19,  44 => 15,  40 => 13,  38 => 12,  32 => 8,  26 => 5,  23 => 4,  21 => 3,  17 => 1,);
    }
}
