<?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 (isset($context["app"])) { $_app_ = $context["app"]; } else { $_app_ = null; }
        if ($this->getAttribute($this->getAttribute($_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
            if (isset($context["app"])) { $_app_ = $context["app"]; } else { $_app_ = null; }
            echo twig_escape_filter($this->env, $this->getAttribute($this->getAttribute($_app_, "session"), "flash", array(0 => "notice"), "method"), "html", null, true);
            echo "
    </div>
";
        }
        // line 8
        echo "
<div id=\"override_javascript_alert\"></div>
<div id=\"override_javascript_alertx\"></div>
<br />
        ";
        // line 12
        if (isset($context["history"])) { $_history_ = $context["history"]; } else { $_history_ = null; }
        if (((($this->getAttribute($_history_, "checksHistory", array(), "any", true, true) && ($this->getAttribute($_history_, "checksHistory") != null)) || ($this->getAttribute($_history_, "totalAssist", array(), "any", true, true) && ($this->getAttribute($_history_, "totalAssist") != null))) && ($this->getAttribute($_history_, "isActive") == 1))) {
            // line 13
            echo "            <div style=\"border:3px solid gray; border-radius: 9px; width:95%; padding:25px;\">

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

                ";
            // line 31
            if (isset($context["app"])) { $_app_ = $context["app"]; } else { $_app_ = null; }
            $context["uri"] = $this->getAttribute($this->getAttribute($_app_, "request"), "uri");
            // line 32
            echo "                ";
            if (isset($context["uri"])) { $_uri_ = $context["uri"]; } else { $_uri_ = null; }
            if (($this->env->getExtension('security')->isGranted("ROLE_ADMIN") && (!twig_in_filter("/assistance/", $_uri_)))) {
                // line 33
                echo "                    ";
                if (isset($context["history"])) { $_history_ = $context["history"]; } else { $_history_ = null; }
                $context["urlpath"] = $this->env->getExtension('routing')->getPath("DorcasTabithaBundle_assistance_delete_history", array("history_id" => $this->getAttribute($_history_, "historyid")));
                // line 34
                echo "                    <input type=\"button\" value=\"Delete History\" onClick=\"location.href='";
                if (isset($context["urlpath"])) { $_urlpath_ = $context["urlpath"]; } else { $_urlpath_ = null; }
                echo twig_escape_filter($this->env, $_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
        if (isset($context["assistance"])) { $_assistance_ = $context["assistance"]; } else { $_assistance_ = null; }
        echo twig_escape_filter($this->env, $this->env->getExtension('routing')->getPath("DorcasTabithaBundle_assistance_create", array("client_id" => $this->getAttribute($this->getAttribute($_assistance_, "client"), "clientid"))), "html", null, true);
        echo "\" method=\"post\" ";
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderEnctype($_form_);
        echo " class=\"dorcas\">

    <h4>Food Given:</h4>

<div id=\"western_wake\">
            ";
        // line 50
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "food_given"));
        echo "
            ";
        // line 51
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "food_given"));
        echo "
            ";
        // line 52
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "food_given"), array("attr" => array("size" => "3", "onchange" => "fgcheckbox(this)")));
        echo " 
        </div>
        <div id=\"western_wake_date\";>
            ";
        // line 55
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "food_given_date"));
        echo "
            ";
        // line 56
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "food_given_date"));
        echo "
            ";
        // line 57
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_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
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "checkpurpose"), array("attr" => array("style" => "width: 160px;")));
        echo "
        </div>
        <div style=\"width:12%; float:left;\">
                    ";
        // line 73
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "checks_issued_date"));
        echo "
                    ";
        // line 74
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "checks_issued_date"));
        echo "
                    ";
        // line 75
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "checks_issued_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 78
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "checks_issued_payee"));
        echo "
                    ";
        // line 79
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "checks_issued_payee"));
        echo "
                    ";
        // line 80
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "checks_issued_payee"), array("attr" => array("size" => "30")));
        echo "
        </div>

        <div style=\"width:11%; float:left;\">
                    ";
        // line 84
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "check_dorcas"));
        echo "
                    ";
        // line 85
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "check_dorcas"));
        echo "
                    ";
        // line 86
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "check_dorcas"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo " 
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 89
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "check_oasis"));
        echo "
                    ";
        // line 90
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "check_oasis"));
        echo "
                    ";
        // line 91
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "check_oasis"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 94
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "check_sfumc"));
        echo "
                    ";
        // line 95
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "check_sfumc"));
        echo "
                    ";
        // line 96
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "check_sfumc"), array("attr" => array("size" => "10", "onchange" => "isNumber(this)")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 99
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "check_other"));
        echo "
                    ";
        // line 100
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "check_other"));
        echo "
                    ";
        // line 101
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_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
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "special_program"), array("attr" => array("style" => "width: 220px;")));
        echo "
        </div>
        <div style=\"width:12%; float:left;\">
                    ";
        // line 113
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "special_program_date"));
        echo "
                    ";
        // line 114
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "special_program_date"));
        echo "
                    ";
        // line 115
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "special_program_date"), array("attr" => array("size" => "11", "class" => "datepicker")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 118
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "special_program_recipient_name"));
        echo "
                    ";
        // line 119
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "special_program_recipient_name"));
        echo "
                    ";
        // line 120
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "special_program_recipient_name"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div style=\"width:26%; float:left;\">
                    ";
        // line 123
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "special_program_parent_name"));
        echo "
                    ";
        // line 124
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "special_program_parent_name"));
        echo "
                    ";
        // line 125
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_form_, "special_program_parent_name"), array("attr" => array("size" => "30")));
        echo "
        </div>
        <div style=\"width:11%; float:left;\">
                    ";
        // line 128
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderLabel($this->getAttribute($_form_, "special_program_check"));
        echo "
                    ";
        // line 129
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderErrors($this->getAttribute($_form_, "special_program_check"));
        echo "
                    ";
        // line 130
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderWidget($this->getAttribute($_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
        if (isset($context["form"])) { $_form_ = $context["form"]; } else { $_form_ = null; }
        echo $this->env->getExtension('form')->renderRest($_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 (  370 => 141,  355 => 130,  350 => 129,  345 => 128,  338 => 125,  333 => 124,  328 => 123,  321 => 120,  316 => 119,  311 => 118,  304 => 115,  299 => 114,  294 => 113,  287 => 110,  274 => 101,  269 => 100,  264 => 99,  257 => 96,  247 => 94,  240 => 91,  223 => 86,  218 => 85,  213 => 84,  205 => 80,  195 => 78,  188 => 75,  183 => 74,  171 => 70,  149 => 56,  137 => 52,  72 => 26,  40 => 12,  21 => 3,  252 => 95,  248 => 74,  244 => 73,  236 => 71,  230 => 89,  225 => 63,  222 => 62,  212 => 50,  204 => 50,  200 => 79,  197 => 47,  177 => 40,  160 => 35,  157 => 34,  126 => 18,  106 => 13,  98 => 6,  184 => 42,  181 => 77,  173 => 38,  163 => 36,  155 => 63,  139 => 22,  135 => 58,  133 => 57,  114 => 15,  110 => 49,  105 => 47,  93 => 112,  76 => 30,  69 => 47,  209 => 78,  206 => 51,  201 => 76,  194 => 71,  191 => 70,  186 => 67,  180 => 41,  176 => 61,  166 => 66,  158 => 64,  153 => 55,  143 => 49,  134 => 20,  123 => 40,  118 => 16,  90 => 33,  87 => 27,  66 => 27,  60 => 39,  146 => 50,  136 => 41,  122 => 17,  107 => 48,  101 => 35,  95 => 29,  82 => 25,  73 => 20,  67 => 17,  52 => 30,  109 => 41,  104 => 34,  96 => 32,  84 => 62,  80 => 24,  26 => 4,  34 => 8,  112 => 21,  102 => 19,  89 => 16,  63 => 40,  56 => 12,  43 => 13,  92 => 28,  79 => 29,  57 => 21,  46 => 7,  37 => 7,  33 => 4,  29 => 6,  19 => 1,  44 => 16,  27 => 5,  55 => 19,  45 => 25,  36 => 8,  50 => 18,  47 => 15,  30 => 4,  25 => 3,  249 => 96,  239 => 72,  235 => 90,  228 => 84,  224 => 82,  219 => 80,  217 => 58,  214 => 79,  211 => 77,  208 => 76,  202 => 72,  199 => 71,  193 => 44,  182 => 63,  178 => 73,  175 => 60,  172 => 59,  165 => 55,  161 => 57,  156 => 51,  154 => 57,  150 => 31,  147 => 30,  132 => 51,  127 => 50,  117 => 51,  113 => 34,  86 => 32,  83 => 31,  78 => 15,  68 => 9,  64 => 22,  61 => 21,  48 => 10,  39 => 8,  32 => 5,  24 => 4,  22 => 4,  23 => 3,  20 => 2,  17 => 1,  144 => 55,  138 => 46,  130 => 19,  124 => 54,  121 => 41,  115 => 45,  111 => 36,  108 => 31,  99 => 43,  94 => 34,  91 => 71,  88 => 16,  85 => 26,  77 => 58,  74 => 20,  71 => 54,  65 => 45,  62 => 15,  58 => 34,  54 => 32,  51 => 10,  42 => 9,  38 => 8,  35 => 7,  31 => 4,  28 => 3,);
    }
}
