Landing page programmed in Mailchimp

Hi there,
We urgently need a landing page programmed in Mailchimp for GDPR purposes.
On the landing page, there needs to be a sign up form where users can opt in to receive emails from us.

The design of the landing page will need to the follow the design of the HTML.

Nearly there! Please click the box below if you want to hear from us.

2 fields which link through to Mailchimp:

1) Their email address (already encrypted)

2) {{ }} Yes! Keep me updated

You can change your mind at anytime by clicking the unsubscribe link in the footer of any email you receive from us.