Calculator for accommodation website

It is a form to calculate the cost for accommodation on a website for a hunting lodge. The client does not have a database, therefore tariffs must be hard coded (not good idea for me, but that's what client wants) The calculator must be an add on to an existing html website. Following input fields: (all must be compulsory fields) Name (text field) Email address (text field, email validation required) How many persons (Dropdown field, 1/2/3/4/5....) How many children (Dropdown field,1/2/3...) + age Room types (Dropdown field, Double / Single / Family) Dates From (dd/mm/yy) To (dd/mm/yy) (date formatted fields) Nights (1/2/3...) - calculated from above field (no input require from visitor) Meals (Dropdown field, Self Catering / Chef prepared) Hunt Game (Radio buttons, List of available game) Require Transfers (Dropdown field, airport to lodge or lodge to the airport or both ways) Captcha image or similar security build in to prevent spam. Submit button On completion, pressing the calculate button, one copy to be mailed to the possible visitor (captured from form) and another send to the lodge owner.