392030 One page race registration

I need a Zen Cart programmer to create a one page sign up sheet for a running race. A layout example is attached. The user will select either Individual or Family and fill in required information. The user cannot select both Family and Individual. A validation check will be required for the form: first family member, primary contact information (except email) and initials checkbox. The total at the bottom is the sum of registration and raffle. Clicking Proceed to Payment sends the items and price to Paypal. All Family, Individual and Primary Contact registration information is sent to the Zen Cart data base. Successful Paypal registration payment sends the user back to the main page. All modified Zen Cart files should be in override folders.