Out of office custom webpage. - repost

Objective: I'm building a single page website that anyone can use as an out of office (it's actually for a specific event). Users click a link for a popup/page form to submit very basic details which outputs a unique url with then name/dates on the page so they can share it. Fields of the form: * name (single test field – users can enter anything) * start date * end date * Choose output formatting (global date options) * select any background images they wish to exclude (multiple possible - via checkbox - pool of large images) * select open graph main image (for facebook share - pool of small images) > after user submits unique url is generated [login to view URL][startday][end-day] for them to share. url will live forever. Other features: * no login required (user or admin) * fields are optional – of name isn't entered canonical meta link should point to homepage * if name is entered name comes up in the eg [name] sitename] * apostrophes and weird characters are allowed in the name but stripped out of the url * Ideally users can preview the output as they type. Technology: * php/jquery * mysql database but site needs to be fast Bonus: * I have the basic page built, can handle the html/css but could do with some jquery tweaking, small stuff like clearing multiple panels. * Experience in responsive design desirable.