{% extends '../template.html' %}
{% block title %}New Blacklist{% endblock %}
{% block subcontent %}
		{% if session.flash.error != "" %}
			{{ session.flash.error | safe }}
		{% endif %}
	
		<h1>New Blacklist</h1>
		<form method="post">
			<table class="data" cellpadding="0" cellspacing="0" border="0">
				<tr>
					<td>Telepon</td>
					<td><input type="text" name="telepon" value="{{ data.telepon }}"/></td>
				</tr>
				<tr>
					<td>Jenis</td>
					<td>
						<select name="jenis">
							<option value="1" {% if data.jenis == "1"%}selected="selected"{%endif%}>ringan</option>
							<option value="2" {% if data.jenis == "2"%}selected="selected"{%endif%}>berat</option>
						</select>
					</td>
				</tr>
				<tr>
					<td>Date</td>
					<td><input type="text" name="date" value="{{ data.date }}"/></td>
				</tr>
				<tr>
					<td>Keterangan</td>
					<td><input type="text" name="keterangan" value="{{ data.keterangan }}"/></td>
				</tr>
				<tr>
					<td>Id center</td>
					<td><input type="text" name="id_center" value="{{ data.id_center }}"/></td>
				</tr>
			</table>
			<br/><input type="submit" value="Submit" /> <a href="{% nav blacklist %}">Cancel</a>
		</form>
{% endblock %}
