I want a totally new website with online registration form

The website is www.kenilworthtownjfc.com

It needs a totally new theme and look. Forget the pictures of the kids etc!

I need to keep the
About
Registration/Subs
Directions
Links
Codes of Conduct
Contact Us

What we do want is to put an online registration form built into it so parents fill in the form and the information is captured.

The registration form needs to have the following fields

Name of Player

Address 1
Address 2
Town
Postcode

Home Telephone No
Email address
Date of Birth


Emergency Contact Details

Name
Mobile No:


Also needs to be a tick box for the below.

I/We wish to join Kenilworth Town Junior Section and agree that I/We will abide by the rules of the Club.
I/We give permission/do not give permission for team photographs to be taken during the course of the season.


Can you give me a fixed price please. This is for an immediate start and further sites will follow if this is a success.

Can you please send me examples of sites you have done with online forms in it!


Thanks

Jayne