Simple Webform with PHP

This project was awarded to aukint for $60 USD.

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Project Budget
$30 - $250 USD
Total Bids
Project Description

See attached forms.

I need a web app that will enter records as seen in the Excel FORM attached to this document.

I prefer PHP and mySQL as I will be hosting locally on my System running XAMPP or WAMP

The Following will be required:

- Web form to Enter Records

- Search page to query records and print out result

- Time Stamp on every record Entered

Field Name Field Type

Date: Calender Selection

Surname Text Field

First Name Text Field

Sex Drop Down Selection (Male/Female)

Age group Drop down selection (Under 18/18-30/30+/40+/50+/60+)

Occupation Text Field

Contact Number (s) Phone Number

Home Address Text Box

Nearest Bus Stop Text Box

Email Email Address

Can we pay you a visit? Drop Down Selection (Yes/No)

If yes, where Address to Visit: Drop Down Selection (Home/Office)

Office Address Text Field

Marital Status Drop Down Selection (Single/Married/Divorced/Widowed)

Born Again? Drop Down Selection (Yes/No)

How did you hear about COZA? Drop Down Selection (Friend/Handbill/Radio/Evangelism/Internet/Others)

Why did you come to Church today? Drop Down Selection (Invited/Live in the Area/Visiting the City of Abuja/Curious About Christianity/Heard about the Church)

Would you like to make COZA your local church Drop Down Selection (Yes/No)

Special Request Check Box Selection (Findout more about COZA/Request prayers for a particular thing/Speak to someone about my Faith)

Comments about Service Text Box

I want search to be perfomed on the following:


Name (First Name and Surname)

Phone Number


Age Group


Can we pay you a visit

Marital Status

Born Again?

How did you hear about COZA

Special Request

The Search Result Summary Page should contain the following fields


First Name

Phone Number

EMail Address


Marital Status

Age Group.

When you click on any of the names in the result page, a popup page should be displayed showing all the information entered about the individual.

The page should also have a password protection system. There will be 3 users

Administator - Can Add, Edit, Remove and Search for records

Manager Can Add, Edit and search

Editor Can Search/View

Phone Number

Awarded to:
Skills Required

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