Build 1 Form page for WordPress - adaptive & secure

The attached design (PSD available) must be integrated in existing WordPress website. Either of ways you choose to work from the versions bellow, all design must be Bootstraped - must adapt well for desktop, mobile and tablets. This project must be ready in 24 hours from awarding, so please bid only if you are ready to start right away and able to finish in time. You can work for this project in 2 ways: Version 1: integrate this Google Form [login to view URL] into the WordPress - code CSS/use Home page CSS so it looks like in attached design. Ensure the displayed language for fields info and submit button will be English; Submit button must look like in the attached design. Keep the header from our existing WordPress website, like in attached design - when click on logo from header, user will be directed to Home page. Version 2: code the form as a page of WordPress, but be sure to use a code that is secure (prevent code injection +captcha required as anti-spam, use ajax scripts - please be aware that our server will not allow simple html forms to send e-mails). The data will be colected in a Database that you will create, in this scenario, and e-mail with submited form each time a user submits form. Required fields will be checked and custom warning message will return if not all required field were completed. Succes message/error message must be returned after user press "submit".