Simple form needed to place reservations on website

i need a form that will do the following: 1- select date 2. select time 3. number of people in group - then create number 3 based on number 2 3. enter persons name (age ,weight and riding ability are drop down menus) 4. enter credit card info to create reservation - needs to be secure ( ill buy an ssl cert for website) 5. create a conformation number and email the person and admin 6.i need to create a limit of how many people per time every day( example if i have 5 time slots then i can only have 10 people per time slot. and when its full i need it to say call and list phone number. and if they select current day the i need to say call the phone. 7. Each person is $45.00 so it needs to total for the reservation when submitted 8. print reports of reservation 9. view reservations and print credit card to process 10. save data to mysql database so i need a simple backend to view reservations and credit card info.