Form / Database Creation Needed

I am looking to contract for the following work.

Create a form exactly as shown here:
starlandkids.com/registration.html
(can this form be reused except for the specific id tags?)

Currently, I am using a third party to host and process this form.
I would like to have our own script on our server to process this form.

Additionally, I would like the data to simultaneously be emailed to a specified address, and be recorded into a database, which will be able to be downloaded and processed through excel.

Please provide a detailed project fee, as well as a realistic completion time.

I would ultimately like to be able to add/edit fields so also please factor in the time to create a brief sheet of explanation on what will be needed to accomplish this.
(a bullet point list of steps is just fine here)


Thanks,
Jake