PHP Script, Gym Challenge

I would like to have a simple php script that captures our employee’s gym activities as an additional company incentive. We have about 200 employees and we are including a free gym membership as an additional benefit. I would like to use a webpage that would capture the data of how many times a staff goes to the gym every month, then every year, and so forth. It can be a webpage that listed all the participant’s name with either check boxes or an input box. The data then will be displayed on a separate webpage (NO DATA BASE PLEASE)

Example:

Name Surname Times per Month Monthly Total Yearly Total

Thank you.

You may want to check this out:

GYM_php_preview