Last Name: @error('last_name') {{ $message }} @enderror

First Name: @error('first_name') {{ $message }} @enderror

Middle Name (optional): @error('middle_name') {{ $message }} @enderror

Email: @error('email') {{ $message }} @enderror

Present Address: @error('present_address') {{ $message }} @enderror

Provincial Address: @error('provincial_address') {{ $message }} @enderror

Mobile No: @error('mobile_number') {{ $message }} @enderror

Alternative Number: @error('alternative_number') {{ $message }} @enderror

Date of Birth: @error('date_of_birth') {{ $message }} @enderror

Age: @error('age') {{ $message }} @enderror

Place of Birth: @error('place_of_birth') {{ $message }} @enderror

Civil Status:

civil_status == 'single' ? 'checked' : '' }}> Single

civil_status == 'married' ? 'checked' : '' }}> Married

civil_status == 'head_of_family' ? 'checked' : '' }}> Head of the Family

civil_status == 'widow' ? 'checked' : '' }}> Widow/er

@error('civil_status') {{ $message }} @enderror

Nationality: @error('nationality') {{ $message }} @enderror

Religion: @error('religion') {{ $message }} @enderror

Height: @error('height') {{ $message }} @enderror

Weight: @error('weight') {{ $message }} @enderror

Name of Spouse (if married): @error('spouse_name') {{ $message }} @enderror

Occupation: @error('spouse_occupation') {{ $message }} @enderror

Mother's Maiden Name @if ($errors->has('mother_maiden_name')) {{ $errors->first('mother_maiden_name') }} @endif

Mother's Occupation @if ($errors->has('mother_occupation')) {{ $errors->first('mother_occupation') }} @endif

Father's Name @if ($errors->has('father_name')) {{ $errors->first('father_name') }} @endif

Father's Occupation @if ($errors->has('father_occupation')) {{ $errors->first('father_occupation') }} @endif

Dependents @if ($errors->has('dependents')) {{ $errors->first('dependents') }} @endif

PhilHealth No. @if ($errors->has('philhealth_no')) {{ $errors->first('philhealth_no') }} @endif

Blood Type @if ($errors->has('blood_type')) {{ $errors->first('blood_type') }} @endif